Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India.
Eur Radiol. 2021 Apr;31(4):2183-2190. doi: 10.1007/s00330-020-07348-w. Epub 2020 Oct 3.
Pulmonary artery pseudoaneurysms (PAPs) are rare, but important and treatable cause of massive haemoptysis. Minimal data exists on their interventional radiology management due to their rarity, especially direct percutaneous injection. Here, we report our experience of direct percutaneous management of such pseudoaneurysms.
Data of patients presenting to our department from January 2014 to November 2019 was retrospectively analysed, who presented with massive haemoptysis, and CT angiography positive for pulmonary artery pseudoaneurysms. Only patients treated with direct percutaneous intervention were included. Twelve patients who were managed endovascularly were excluded from the study. Observations were tabulated under age, sex, underlying pathology, lobe involved, number and size of the pseudoaneurysm, imaging guidance and embolising agent. Technical and clinical success and complications were then analysed.
Twenty-nine pseudoaneurysms were treated in 27 patients with a mean age of 41.4 years. The most common underlying aetiology was tuberculosis (85.1%), with the most common location being bilateral upper lobes (31% each). CT guidance was the most frequently used imaging guidance (26/29). N-butyl cyanoacrylate (NBCA) glue mixture was used in 79.3% and reconstituted thrombin in the remaining 20.7% pseudoaneurysms. Complete technical and clinical success rates were 93.1% and 88.9% respectively. No major complications were seen except for development of significant pneumothorax in one patient.
Pulmonary pseudoaneurysms are rare but fatal cause for massive haemoptysis. Interventional radiology management via direct percutaneous embolisation is a safe and minimally invasive treatment measure in selective patients, with successful outcomes and minimal complication and recurrence rates.
• Pulmonary artery pseudoaneurysms are rare but important and treatable cause of massive haemoptysis. • This study shows the advantages of percutaneous management of these pseudoaneurysms as an alternate to endovascular embolisation, in case endovascular embolisation is not feasible or practical. • It is a safe and minimally invasive treatment, with technical success of 93.1% and clinical success of 88.9% in this study.
肺动脉假性动脉瘤（PAPs）虽少见，但却是导致大咯血的重要且可治疗的原因。由于其罕见性，尤其是直接经皮注射，关于其介入放射学管理的数据很少。在此，我们报告我们对这种假性动脉瘤进行直接经皮治疗的经验。
回顾性分析 2014 年 1 月至 2019 年 11 月期间因大咯血且 CT 血管造影阳性为肺动脉假性动脉瘤而到我院就诊的患者资料。仅纳入接受直接经皮介入治疗的患者。排除了 12 例接受血管内治疗的患者。记录年龄、性别、基础病理、受累肺叶、假性动脉瘤的数量和大小、影像学引导和栓塞剂。然后分析技术和临床成功率及并发症。
27 例患者共 29 个假性动脉瘤，平均年龄为 41.4 岁。最常见的基础病因是肺结核（85.1%），最常见的部位是双侧上叶（各占 31%）。CT 引导是最常用的影像学引导方式（26/29）。79.3%的假性动脉瘤使用了正丁基氰基丙烯酸酯（NBCA）胶混合物，其余 20.7%使用了重组凝血酶。完全技术成功率和临床成功率分别为 93.1%和 88.9%。除 1 例患者发生明显气胸外，无重大并发症。
肺动脉假性动脉瘤虽少见，但却是导致大咯血的致命原因。在选择性患者中，经皮直接栓塞介入放射学治疗是一种安全、微创的治疗措施，可获得成功的结果，且并发症和复发率低。
• 肺动脉假性动脉瘤虽少见，但却是导致大咯血的重要且可治疗的原因。
• 本研究表明，在血管内栓塞不可行或不实用的情况下，经皮治疗这些假性动脉瘤是一种替代方法，具有优势。
• 它是一种安全、微创的治疗方法，本研究中技术成功率为 93.1%，临床成功率为 88.9%。
