Endovascular treatment of large hemoptysis for pulmonary pseudoaneurysm: Report of 23 cases

Purpose: To evaluate the safety and effectiveness of endovascular treatment for massive hemoptysis caused by pulmonary pseudoaneurysm (PAP). Methods: The clinical data, imaging data, and endovascular treatment of 23 patients with massive hemoptysis caused by continuous PAP were retrospectively analyzed. The success, complication, postoperative recurrence rate, and influence of the treatment on pulmonary artery pressure were also evaluated. Results：Nineteen patients with bronchial artery (BA) or NBSA-PA fistula underwent bronchial artery embolization (BAE) + non-bronchial systemic artery embolization (NBSAE) + pulmonary artery embolization (PAE). The pulmonary artery (PA) pressures before and after embolization were 52.11±2.12 (35-69 cmH2O) and 33.58±1.63 (22-44 cmH2O), respectively (P=0.001). Four patients did not have BA or NBSA-PA fistula. Embolization was performed in two patients with distal pulmonalis lobar arteria PAP. Bare stent-assisted micro coil embolization was performed in the other two patients with PAP of main pulmonalis lobar arteria. The PA pressures of the four patients before and after treatment were 24.50±1.32 (22-28 cmH2O) and 24.75±1.70 (22-29 cmH2O), respectively (P=0.850). The technique had 100% success rate with no serious complications and a postoperative recurrence rate of 30%. Conclusion: Endovascular treatment is safe and effective for massive hemoptysis caused by PAP. The presence of BA or NBSA-PA fistula, BAE, or NBSAE can effectively reduce pulmonary hypertension.