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Exclusion of a pulmonary artery aneurysm using a covered stent
  1. N WILSON,
  2. K MCLEOD,

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A 14 year old boy with multiple branch pulmonary arterial stenoses developed complete occlusion of the left pulmonary artery despite previous surgery. Intraoperative radiofrequency assisted stent angioplasty resulted in successful revascularisation of the left lung but angiography several months later showed a large pear shaped false aneurysm of the left pulmonary artery, measuring 20 × 15 mm (left). Owing to distal pulmonary arterial stenoses, the systolic pressure in the aneurysm was more than half systemic with the potential risk of aneurysmal rupture. Catheter intervention was performed to exclude the aneurysm from the pulmonary circulation and a 17 mm long covered Jostent peripheral stent graft (JoMed International AB, Helsingborg, Sweden) was successfully deployed across the neck of the aneurysm. Angiography following deployment showed complete exclusion of the aneurysm without loss of calibre to the left pulmonary artery (right), but two apical branches to the left lower lobe were also occluded by the covered stent. After catheterisation, the patient had transient haemoptysis and chest radiography changes consistent with infarction of left lower lobe segments. Lung function and gas exchange were not compromised and he was discharged home two days after the procedure on aspirin 75 mg once daily.

Seven months after the procedure the patient was well with resolution of chest radiography changes. Large aneurysms of the pulmonary artery are rare but we have demonstrated that they can be successfully treated by a covered stent, thus avoiding surgery, which can be hazardous due to the difficulty in achieving haemostasis deep within the lung parenchyma.