Endovascular treatment of a right pulmonary sequestration supplied by an aneurysmal aberrant artery originating from the abdominal aorta

Abstract

Endovascular embolization of arteries feeding pulmonary sequestrations is a growing therapeutic option. A 51-year-old woman with chest pain and hemoptysis was admitted. During hospitalization she presented 150 mL hemoptysis, hypotension, and hematocrit fell to 23.3%. Contrast-enhanced computed tomography confirmed a pulmonary sequestration irrigated by an aneurysmal artery from the abdominal aorta. The patient underwent endovascular coil embolization of the artery feeding the aneurysm and an Amplatzer device was deployed in the proximal third of the sequestration artery. Subsequent contrast-enhanced computed tomography confirmed complete thrombosis of the aberrant artery feeding the aneurysm and absence of irrigation of the pulmonary sequestration. At 56 months follow-up the patient remains asymptomatic, tomography showed involution of the sequestration and complete thrombosis of the aberrant artery. The challenges presented by the different treatment alternatives are discussed.

Presentation and Management of Pulmonary Sequestration With an Aneurysmal Aberrant Pulmonary Artery

“…Endovascular treatment before surgical resection minimizes the bleeding risk of ligating an aneurysmal vessel and avoids the need for surgical ligation in a separate operative field, particularly when the aberrant artery originates in the abdomen. The drawbacks of the hybrid approach include a prolonged hospital stay for two separate procedures and the possibility of incomplete vascular control when compared to surgical ligation [ 1 , 6 ].…”

“…Bronchopulmonary sequestration (BPS) is characterized by extra-anatomic lung tissue that does not contribute to respiratory function [ 1 ]. It receives blood supply from the systemic circulation, primarily the thoracic (87.4%) and, less commonly the abdominal (10.5%) aorta [ 2 ].…”