International Society For Minimally Invasive Cardiothoracic Surgery

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Thoracic Stent Graft Accompanied By Coil Embolization For Pulmonary Sequestration, An Interesting Case
Fatima G. Wilder, MD, Sarah Minasyan, MD.
UCSF - Fresno, Fresno, CA, USA.

Objective: Thoracic stent graft plus coil embolization is a promising option for management of pulmonary sequestrations. Here we present the case of a 43 year-old male with a history of chronic recurrent chest pain and hemoptysis that was incidentally identified as having a Pryce Type I pulmonary sequestration. Methods: A 43-year old male with gastritis, alcohol abuse, chronic leg and back pain was incidentally found to have an anomalous artery from the descending thoracic aorta to the left lower lobe. Due to recurrent hemoptysis and refractory back pain with no other identifiable etiology, he was consented for coil embolization and thoracic endovascular aortic repair (TEVAR). In conjunction with interventional radiology, coil embolization of the aberrant thoracic artery was performed under fluoroscopic guidance with good graft coverage of the aberrant artery. Results: Post-operatively, the patient was transferred to the cardiovascular intensive care unit for observation and extubation. His post-operative recovery was uneventful and he reported a decrease in his chest pain. Repeat imaging including Chest X-ray and CT Angiography were performed prior to discharge. CT Angiography demonstrated good positioning of the coils as well as the stent graft. The patient was discharged on post-operative day one. Conclusions: Surgical intervention with ligation of the anomalous vessel has historically been the primary intervention for patients with Pryce Type I sequestrations, and it has yielded satisfactory results. However, thoracic stent graft in addition to coil embolization is a minimally invasive management option that should be the first line of treatment because of the minimal physiologic burden on the patient and quicker recovery as compared to traditional thoracotomy.


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