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Fontana F, Piacentino F, Curti M, Ierardi AM, Coppola A, Macchi E, De Marchi G, Faiella E, Santucci D, Moramarco LP, Del Grande F, Piffaretti G, Tozzi M, Imperatori A, Carcano G, Basile A, D'Angelo F, Carrafiello G, Venturini M. Pulmonary Artery Pseudoaneurysms Embolization: Bicentric Experience and Review of the Literature. J Clin Med 2023; 12:jcm12113796. [PMID: 37297991 DOI: 10.3390/jcm12113796] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
The purpose of this bicentric case series was to report the safety, efficacy, and clinical outcome of transcatheter embolization in pulmonary artery pseudoaneurysms (PAPAs). Between January 2016 and June 2021, eight patients with PAPA were subjected to transcatheter embolization. The total number of patients was eight, of which five were female, with a mean age of 62 ± 14 years (average ± standard deviation). Etiology was traumatic in 2/8 cases and iatrogenic in 6/8 cases (after positioning a Swan-Ganz catheter in 5/6 cases and a temporary pacemaker in the latter case). In a single case, the PAPA was incidentally discovered during a routine X-ray, in the remaining 7 cases, the procedure was performed in emergency settings. PAPA embolization was performed using detachable coils alone in 3 cases; coils and glue in 1 case; coils, glue, and vascular plug in 1 case; coils and non-adhesive liquid embolic agents (Onyx and Squid respectively) in 2 cases; and non-adhesive liquid embolic agent alone (Onyx) in 1 case. No peri-procedural or post-procedural complications were recorded. Both the technical and clinical success rates were 100.0%. In conclusion, endovascular embolization is a technically feasible and safe therapeutic option for patients with PAPAs.
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Affiliation(s)
- Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Marco Curti
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Anna Maria Ierardi
- Radiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20021 Milan, Italy
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Edoardo Macchi
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Giuseppe De Marchi
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Eliodoro Faiella
- Radiology Unit, Sant'Anna Hospital, San Fermo della Battaglia, 22042 Como, Italy
- Department of Radiology, Campus Bio-Medico University, 00128 Rome, Italy
| | - Domiziana Santucci
- Radiology Unit, Sant'Anna Hospital, San Fermo della Battaglia, 22042 Como, Italy
- Department of Radiology, Campus Bio-Medico University, 00128 Rome, Italy
| | | | - Filippo Del Grande
- Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale EOC, 6900 Lugano, Switzerland
| | - Gabriele Piffaretti
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- Vascular Surgery Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Matteo Tozzi
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- Vascular Surgery Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Andrea Imperatori
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- Thoracic Surgery Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Giulio Carcano
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- General Surgery Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Antonio Basile
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", 95123 Catania, Italy
| | - Fabio D'Angelo
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- Orthopedic Surgery Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Gianpaolo Carrafiello
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
- Radiology Unit, Sant'Anna Hospital, San Fermo della Battaglia, 22042 Como, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
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De Smet D, Payen MC, Remes J, Van den Wijngaert S, Vouche M, Konopnicki D. Tuberculosis and pseudoaneurysms. Med Mal Infect 2020; 50:446-450. [PMID: 32081503 DOI: 10.1016/j.medmal.2020.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/20/2019] [Accepted: 01/28/2020] [Indexed: 11/24/2022]
Affiliation(s)
- D De Smet
- CHU Saint-Pierre, Brussels, Belgium.
| | | | - J Remes
- CHU Saint-Pierre, Brussels, Belgium
| | | | - M Vouche
- CHU Saint-Pierre, Brussels, Belgium
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Parrot A, Tavolaro S, Voiriot G, Canellas A, Assouad J, Cadranel J, Fartoukh M. Management of severe hemoptysis. Expert Rev Respir Med 2018; 12:817-829. [PMID: 30198807 DOI: 10.1080/17476348.2018.1507737] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Though rare, severe hemoptysis (SH) is associated with a mortality rate exceeding 50% when not managed properly. Areas covered: This paper reviews the recent epidemiological data regarding SH, the role of multidetector computed tomography angiography (MDCTA), and fiberoptic bronchoscopy (FOB) in its management, as well as the value of current treatments. Expert commentary: MDCTA is becoming an essential modality, since it allows determining the location, etiology, and mechanism of the bleeding. FOB can be delayed, except when local control of bleeding is required. Emergency treatment relies on interventional radiology. Both bronchial and non-bronchial arteries should be explored during bronchial arteriography. Surgery must be considered in all operable patients if the cause of hemoptysis persists.
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Affiliation(s)
- Antoine Parrot
- a Service de Pneumologie , AP-HP, Hôpitaux Universitaires de l'Est Parisien, Pôle TVAR, Hôpital Tenon , Paris , France
| | - Sebastian Tavolaro
- b Service de Radiologie , AP-HP, Hôpitaux Universitaires de l'Est Parisien Hôpital Tenon , Paris , France.,c Médecine Sorbonne Université , Paris , France
| | - Guillaume Voiriot
- c Médecine Sorbonne Université , Paris , France.,d Service de Réanimation et USC médico-chirurgicale , AP-HP, Hôpitaux Universitaires de l'Est Parisien, Pôle TVAR, Hôpital Tenon , Paris , France
| | - Antony Canellas
- a Service de Pneumologie , AP-HP, Hôpitaux Universitaires de l'Est Parisien, Pôle TVAR, Hôpital Tenon , Paris , France.,c Médecine Sorbonne Université , Paris , France
| | - Jalal Assouad
- c Médecine Sorbonne Université , Paris , France.,e Service de chirurgie thoracique et vasculaire , AP-HP, Hôpitaux Universitaires de l'Est Parisien, Pôle TVAR, Hôpital Tenon , Paris , France
| | - Jacques Cadranel
- a Service de Pneumologie , AP-HP, Hôpitaux Universitaires de l'Est Parisien, Pôle TVAR, Hôpital Tenon , Paris , France.,c Médecine Sorbonne Université , Paris , France
| | - Muriel Fartoukh
- c Médecine Sorbonne Université , Paris , France.,d Service de Réanimation et USC médico-chirurgicale , AP-HP, Hôpitaux Universitaires de l'Est Parisien, Pôle TVAR, Hôpital Tenon , Paris , France
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Gabrielli D, Giammarino A, Delli Pizzi A, Martino G, Mazza R, Timpani C, Cotroneo AR. Embolization of Bleeding Pulmonary Arterial Pseudoaneurysm in a Woman With Infective Endocarditis. Ann Thorac Surg 2018; 106:e61-e63. [PMID: 29630872 DOI: 10.1016/j.athoracsur.2018.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 02/27/2018] [Accepted: 03/04/2018] [Indexed: 10/17/2022]
Abstract
Pulmonary arterial pseudoaneurysm is a rare but life-threatening complication of infective endocarditis. This report describes a case of bleeding pulmonary arterial pseudoaneurysm in a young, drug-addicted woman with tricuspid annuloplasty after infective endocarditis that was promptly identified by computed tomography pulmonary angiography and successfully treated using coil embolization. Perfusion scintigraphy at 30 days confirmed the safety of endovascular treatment.
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Affiliation(s)
- Daniela Gabrielli
- Department of Neuroscience and Imaging, Institute of Radiology, Section of Diagnostic Imaging and Therapy-Radiology Division, G. d'Annunzio University, Chieti, Italy.
| | - Alberto Giammarino
- Department of Neuroscience and Imaging, Institute of Radiology, Section of Diagnostic Imaging and Therapy-Radiology Division, G. d'Annunzio University, Chieti, Italy
| | - Andrea Delli Pizzi
- ITAB Institute of Advanced Biomedical Technologies, G. d'Annunzio University, Chieti, Italy
| | - Gianluigi Martino
- Department of Radiological Sciences, Institute of Nuclear Medicine, SS. Annunziata Hospital, Chieti, Italy
| | - Rocco Mazza
- Department of Radiological Sciences, Institute of Nuclear Medicine, SS. Annunziata Hospital, Chieti, Italy
| | - Carmine Timpani
- Department of Neuroscience and Imaging, Institute of Radiology, Section of Diagnostic Imaging and Therapy-Radiology Division, G. d'Annunzio University, Chieti, Italy
| | - Antonio Raffaele Cotroneo
- Department of Neuroscience and Imaging, Institute of Radiology, Section of Diagnostic Imaging and Therapy-Radiology Division, G. d'Annunzio University, Chieti, Italy
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Bronchial Artery Embolization with Large Sized (700-900 µm) Tris-acryl Microspheres (Embosphere) for Massive Hemoptysis: Long-Term Results (Clinical Research). Cardiovasc Intervent Radiol 2017; 41:225-230. [PMID: 29067512 DOI: 10.1007/s00270-017-1818-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the safety, efficacy and long-term results of bronchial artery embolization with microsphere particles (Embosphere® Microspheres, BioSphere Medical, Rockland, MA) 700-900 µm in size for massive hemoptysis. METHODS One hundred and seventy-four patients (94 female, 80 male; mean age 39.4 ± 5.7) who had bronchial artery embolization for massive hemoptysis between January 2010 and October 2015 were incorporated in the study. Patients had hemoptysis with a mean volume of 525 ± 150 mL (median 500 mL, range 300-1200 mL) over a 24-h period. Underlying pathologies included bronchial artery hypertrophy due to bronchiectasis (56.3% [98/174]), lung cancer (29.9% [52/174]), tuberculosis (10.3% [18/174]) and the rest remained idiopathic (3.4% [6/174]). Mean bronchial artery diameter before the intervention was 3.8 ± 1.5 mm (median 4 mm, range 3.1-7.5 mm). Median follow-up period was 56 months (range 10-82 months). Primary objectives were the technical and clinical success. RESULTS Technical success was 100%. Clinical success for preventing massive hemoptysis was 91.9% (160/174). There was no procedure-related mortality or morbidities. Minor complications such as chest pain were observed in nine patients (5.0%). Recurrent hemoptysis (8.1%) was observed within 6 months in 14 patients, ten of whom were treated with a second embolization session and the remaining four with a total of three embolization sessions. CONCLUSION Bronchial artery embolization for massive hemoptysis with Embosphere particles 700-900 µm in size is a safe and effective method with high technical and clinical success rates. Long-term results are excellent.
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