Pulmonary artery occlusion with ethylene vinyl alcohol copolymer in patients with hemoptysis: initial experience in 12 cases.

OBJECTIVE: The purpose of this study was to evaluate the feasibility and efficacy of pulmonary artery occlusion with ethylene vinyl alcohol copolymer in patients with hemoptysis. MATERIALS AND METHODS: We reviewed the cases of 12 consecutively registered patients (10 men, two women; age range, 21-83 years; mean, 54.5 years) who were treated for hemoptysis by pulmonary artery occlusion with ethylene vinyl alcohol copolymer. The indications, immediate hemoptysis control, and clinical tolerability were analyzed. RESULTS: The underlying diseases were necrotizing pneumonia in four patients, necrotizing aspergillosis in one patient, complex aspergilloma in two patients, active tuberculosis in two patients, lung cancer in two patients, and Behçet disease in one patient. Ethylene vinyl alcohol copolymer was used alone in nine patients and with steel coils in three patients. The main indications were a small-necked pulmonary artery pseudoaneurysm in five patients, necrotic process in four patients, presence of systemic reperfusion of a pulmonary artery pseudoaneurysm in one patient, absolute necessity for anticoagulation therapy in one patient, and need to complete pulmonary artery aneurysm sac occlusion in one patient. The injection procedure was well tolerated. Hemoptysis of pulmonary arterial origin was controlled in all but one patient, who had progression of the infectious disease and underwent surgery. In two patients, hemoptysis recurred from systemic arteries and was treated with embolization of the systemic arteries in one patient and surgery in the other patient. CONCLUSION: Ethylene vinyl alcohol copolymer embolization for hemoptysis of pulmonary arterial origin is feasible and efficacious. Use of this embolization agent is beneficial in patients with pulmonary artery injuries, especially those with small-necked lesions.

Systemic arterial embolization in patients with hemoptysis: initial experience with ethylene vinyl alcohol copolymer in 15 cases.

OBJECTIVE: The purpose of this study was a preliminary evaluation of the use of ethylene vinyl alcohol copolymer to treat patients with hemoptysis of systemic arterial origin. MATERIALS AND METHODS: We reviewed the cases of 15 consecutively registered patients (10 men, five women; mean age, 53.7 years) who underwent endovascular administration of ethylene vinyl alcohol copolymer in the management of hemoptysis. The indications, immediate control of hemoptysis, and clinical tolerability were analyzed. RESULTS: The indications for embolization were mainly early recurrence of hemoptysis with reperfusion of systemic arteries in seven cases; unstable microcatheter in two cases; large ectopic bronchial artery in two cases; and, in one case each, bronchial arterial bleeding through a small anastomotic network, aneurysm of the left internal thoracic artery in a patient with invasive aspergillosis, a potentially risky connection between the bronchial and right coronary arteries, and occlusion of a systemic artery due to Pryce type 1 intralobar lung sequestration. Hemoptysis was controlled in all but one case and did not recur in the other 14 cases. The injection procedure was well tolerated. CONCLUSION: Ethylene vinyl alcohol copolymer embolization for hemoptysis of systemic arterial origin is feasible. The agent seems beneficial in the care of patients with recurrent hemoptysis after previous bronchial arterial embolization, patients who would be at high risk during embolization with microparticles, and patients who need embolization of large systemic arteries through small-caliber anastomoses.

Massive hemoptysis due to Rasmussen aneurysm: detection with helicoidal CT angiography and successful steel coil embolization.

OBJECTIVE: To present the successful management of two cases of massive hemoptysis related to pulmonary aneurysms in patients with active tuberculosis. DESIGN AND SETTING: Retrospective study in the respiratory intensive care unit (ICU) of a university hospital. PATIENTS: Between July 1996 and January 2002, 46 cases of hemoptysis related to active tuberculosis needed ICU admission. In two cases, pulmonary aneurysm was the source of bleeding. RESULTS: Diagnosis was suspected on enhanced CT scan and confirmed by pulmonary angiograms. Transcatheter occlusion of pulmonary arterial circulation was successful. Both patients were alive at 1-year follow-up. CONCLUSIONS: Massive hemoptysis occurring in patients with active tuberculosis could arise from pulmonary aneurysms. In such cases, bronchial artery embolization is ineffective. Before referring those patients for emergency surgery, an alternative strategy using angiographic study and transcatheter occlusion of pulmonary arterial circulation might be of interest.