Systemic Artery to Pulmonary Artery Fistula Associated with Mitral Regurgitation: Successful Treatment with Endovascular Embolization

Abstract

We present the case of a 60-year-old woman with symptomatic mitral regurgitation caused by a left-to-right shunt via anastomoses consisting of microfistulae, most likely of inflammatory origin, between the right subclavian artery and the right pulmonary artery. The three arteries responsible for fistulous formation, including the internal mammary, thyrocervical, and lateral thoracic arteries, were successfully occluded by transcatheter embolization using superabsorbent polymer microsphere (SAP-MS) particles combined with metallic coils. No complications have been identified following treatment with SAP-MS particles. This approach significantly reduced the patient's mitral regurgitation and she has remained asymptomatic for more than 4 years.

Endovascular Treatment of a Systemic-to-Pulmonary Artery Fistula: A Case Report

“…So it is important to confirm the presence of these fistulae and treatment ( 2 ). Most reported cases were treated by surgery, and only a few received endovascular treatment ( 5 ). Diagnosis by CT is challenging because CT cannot show a hemodynamic state, such as retrograde flow in the pulmonary artery.…”

“…The natural course of S-PAF is unknown, and no established standard treatment exists. Although treatment is controversial, transcatheter embolization has shown success ( 5 ). Although retrograde access is technically challenging with a possibility of recurrence due to overflow to adjacent vessels, a stepwise retro- and antegrade approach was supported ( 9 ).…”

“…Most patients acquire S-PAF from trauma, neoplasms, or inflammatory lesions ( 4 ). Published reports show surgical or endovascular treatment options, with the latter favoured due to minimal invasiveness ( 5 ). Favourable endovascular treatments include systemic artery embolization, although the presence of multiple feeders and draining vessels may prove challenging ( 6 ).…”

Chest wall systemic artery-to-pulmonary artery vascular malformation treated by embolization of feeders and drainers: A case report

“…Surgical management and endovascular embolization have been reported to be useful treatments [ 2 , 3 ]. Embolization of the feeding systemic artery is the most common endovascular embolization technique [ 1 , 2 , 5 , 6 ]. Here, we report a case of systemic artery-to-PA vascular malformation (VM) on the chest wall that was successfully treated by embolization of both feeders and drainers.…”