Abstract No. 115 Pulmonary Artery Pseudoaneurysm: Endovascular Treatment of an Ominous Lesion

To investigate the technique and outcomes of pulmonary artery pseudoaneurysm embolization. Retrospective study of 13 patients with 14 pulmonary artery pseudoaneurysms (PSA) that underwent embolization between January 2014 and September 2023. Lesion characteristics, embolization technique, clinical outcomes and adverse events were reviewed. Etiology of the PSA was iatrogenic (4/13), tumor (3/13), chronic lung disease (2/13), idiopathic (2/13) and mycotic (2/13). Clinical presentation was massive hemorrhage (6/13), incidental (4/13), and non-massive hemoptysis (3/13). The average PSA size was 13.5 mm (8-30 mm range). Embolization was performed with coils in all patients and lesions (13/13 and 14/14 respectively), with addition of vascular plugs in 4 patients, and polyvinyl alcohol (PVA) in 3 patients. Embolization of the PSA sac was performed in all but two extenuating cases (11/13), including occlusion of the PSA inflow and outflow in 7/13 cases (7/14 lesions), inflow without outflow in 3 cases (4 lesions) and sac-only in 1 case. Unlike previous studies1, 2, bronchial artery angiography was not performed. In one of the extenuating cases, massive hemorrhage from an iatrogenic injury was emergently treated with proximal embolization of the inflow pulmonary artery only. In the second case, massive hemorrhage resulting from a left main PSA caused by a lung tumor was embolized with PVA distally and a large Amplatzer plug across the lesion. Occlusion of the PSA was achieved in all cases. In one case (1/13), minor hemoptysis reoccurred one week after treatment due to persistent inflow of the sac from small arteries, which was effectively treated with PVA embolization of the subsegmental feeding artery. Follow-up of 12 patients (one deceased from arrhythmia) over an average 5.3-month period (0–20-month range) showed persistent occlusion of the PSA in all cases (100%). There were no major adverse events attributed to the embolization. Coil migration to the airways occurred in one lung cancer patient due to bronchopulmonary fistulation of the mass; however, the PSA remained occluded. Two patients (2/13) experienced self-resolving pleuritis. Of note, 5/10 patients with procedures performed at least one year before the time of this study were noted to be deceased after an average 7-month time (0–14-month range). Pulmonary artery PSAs of various etiologies can be safely and effectively treated by embolizing the PSA sac, inflow, and outflow pulmonary arteries. However, long-term prognosis of underlying disease may be poor.