Peripheral Pulmonary Arterial Pseudoaneurysms: Therapeutic Implications of Endovascular Treatment and Angiographic Classifications

Abstract

Classification of PAPs on the basis of angiographic findings and determination of treatment options according to these findings are useful for the endovascular management of PAPs associated with massive hemoptysis.

Interventional Therapeutic Strategy for Hemoptysis Originating from Infectious Pulmonary Artery Pseudoaneurysms

“…Hemoptysis of 4 300 mL in 24 hours is associated with a case-fatality rate of 4 50% if appropriate treatment is not initiated (1,2). Of hemoptysis cases, o 10% are due to bleeding from the pulmonary artery (1)(2)(3).…”

“…Of hemoptysis cases, o 10% are due to bleeding from the pulmonary artery (1)(2)(3). Pulmonary artery pseudoaneurysm (PAP) is present in 4% of cases of massive hemoptysis in chronic lung disease with pulmonary cavitation, and the mortality rate for PAP rupture is high (87%) (4).…”

“…Pulmonary artery pseudoaneurysm (PAP) is present in 4% of cases of massive hemoptysis in chronic lung disease with pulmonary cavitation, and the mortality rate for PAP rupture is high (87%) (4). A specific treatment strategy is required when multidetector row computed tomography (CT) angiography confirms the presence of a PAP at a bleeding site in a patient with chronic lung disease because PAPs receive the pulmonary and the systemic arterial supply secondary to the enlargement of an inflammation-induced anastomosis from a systemic artery to a pulmonary artery (2,5). Shin et al (2) classified PAPs into four different types based on systemic and pulmonary angiography findings.…”

“…A specific treatment strategy is required when multidetector row computed tomography (CT) angiography confirms the presence of a PAP at a bleeding site in a patient with chronic lung disease because PAPs receive the pulmonary and the systemic arterial supply secondary to the enlargement of an inflammation-induced anastomosis from a systemic artery to a pulmonary artery (2,5). Shin et al (2) classified PAPs into four different types based on systemic and pulmonary angiography findings. In their study, pulmonary artery embolization after bronchial and nonbronchial systemic artery embolization was effective for type A and B PAPs detected by pulmonary angiography (type A) and selective pulmonary angiography (type B).…”

“…In their study, pulmonary artery embolization after bronchial and nonbronchial systemic artery embolization was effective for type A and B PAPs detected by pulmonary angiography (type A) and selective pulmonary angiography (type B). This study reports six cases of hemoptysis originating from infectious PAPs that were treated with selective pulmonary artery embolization combined with systemic artery embolization using the classification system proposed by Shin et al (2).…”