Transcatheter vascular plugs for the treatment of massive haemoptysis from Rasmussen aneurysms

Rasmussen aneurysms are abnormalities of the pulmonary arterial system caused by tuberculosis (TB). They are associated with a high mortality rate when they cause life-threatening haemoptysis. High TB-prevalence regions have a large burden of TB-related haemoptysis but often limited resources. This series of 25 patients who presented with life-threatening haemoptysis from current and/or previous TB were found to have abnormal pulmonary arteries on computed tomography pulmonary angiogram (CTPA), which were judged to be likely contributors to their bleeding, either in isolation or with concomitant abnormal bronchial or systemic vasculature. These patients underwent transcatheter placement of Amplatzer vascular plugs in the feeder pulmonary artery. Bronchial and systemic lesions were addressed separately as needed. Immediate technical success was achieved in all patients, but four of them experienced intraoperative haemoptysis related to dislodgement of the occluding platelet plug by the high-pressure automatic injector and wire. At 48 hours after the procedure, 18 (72%) remained haemoptysis-free. Six of these experienced recurrence within 1 year of their procedure. Pulmonary artery placement of an Amplatzer vascular plug is a feasible option for treating bleeding Rasmussen aneurysms, but should be part of a combined approach to addressing suspected culprit vascular lesions in all intrathoracic vascular systems.