[Endovascular treatment of chronic pulmonary aspergillosis complicated by massive hemoptysis using a dual-circulation approach: a case report].

Abstract

Chronic pulmonary aspergillosis is a common disease of the respiratory system, with hemoptysis being the most frequent cause of death in such patients. This article reports a case of chronic pulmonary aspergillosis complicated by massive hemoptysis. The patient exhibited abnormal changes in vascular anatomy. A dual-circulation approach, involving both pulmonary and systemic circulations, was adopted, with punctures performed via the femoral vein, femoral artery, and radial artery, and the procedure was successfully completed. Preoperative CT angiography of the pulmonary arteries, pulmonary veins, and bronchial arteries indicated involvement of both the systemic and pulmonary arteries. Initially, dual pulmonary artery angiography was performed via the femoral vein approach, revealing dilation of the right pulmonary artery trunk and non-visualization of the distal segments due to low perfusion. Subsequently, angiography via the femoral artery approach demonstrated multiple dilated and tortuous bronchial and systemic arteries, with disordered distal branches, systemic-pulmonary artery shunts, and distal pulmonary artery aneurysmal dilation. Embolization of the pulmonary artery aneurysmal dilation was performed via the femoral vein approach, and embolization of the bronchial arteries in their normal locations was conducted via the femoral artery approach. Due to severe tortuosity of some non-bronchial systemic arteries (branches of the right subclavian artery), embolization using particulate embolic agents was carried out via the radial artery approach. The procedure was successful, and at the six-month follow-up, the patient had no recurrence of hemoptysis.