Retrospective comparision of embolization and conservative therapy for pulmonary artery pseudoaneurysm.

OBJECTIVE

To compare the efficacy and prognosis of endovascular treatments (support auxiliary spring coil embolization (SASCE) and coil embolization alone) versus medical therapy for pulmonary artery pseudoaneurysm (PAP), and to provide optimized treatment and management strategies for clinical practice.

METHODS

Data from PAP patients who received endovascular or medical therapy at our hospital between 2016 and 2022 were retrospectively collected. Univariate and multivariate binary logistic regression analyses were performed; forest plots and Kaplan-Meier survival curves were generated to illustrate differences between groups.

RESULTS

A total of 148 PAP patients (90 males, 58 females; mean age 59.60 ± 12.60 years) were enrolled. Underlying diseases: pulmonary tuberculosis (n = 98), pulmonary infection (n = 46), lung cancer (n = 4). Treatment modalities: SASCE (n = 22), coil embolization (n = 100), medical therapy (n = 26). During follow-up, the recurrence rate was 39.18% and the mortality rate 18.91%. Age, underlying disease, pseudoaneurysm morphology, and surgical procedure (P < 0.05) were independent influencing factors for PAP recurrence. Both SASCE and coil embolization were associated with better prognosis than medical therapy (HR = 0.13 and 0.20, respectively; P < 0.05). Recurrent massive hemoptysis was associated with a significantly higher mortality (HR = 5.89, P < 0.05). Subgroup analysis suggested that SASCE was numerically superior to coil embolization alone, but the difference was not statistically significant (HR = 0.46, P > 0.05).

CONCLUSION

Compared with medical therapy, endovascular embolization shows potential advantages in improving progression-free survival (PFS) and reducing the risk of hemoptysis recurrence and death. SASCE appeared numerically better than coil embolization alone, but the difference was not statistically significant.