Thoracic Stent Graft Accompanied by Coil Embolization for Pulmonary Sequestration.

ABSTRACT

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 chronic recurrent chest pain and hemoptysis that was incidentally identified as having a Pryce Type I pulmonary sequestration. The patient had a known history of gastritis, alcohol abuse, chronic leg and back pain, and 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. 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 with an endovascular graft. The patient's postoperative 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 postoperative day 1. 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 considered as the first line of treatment because of the minimal physiologic burden on the patient and quicker recovery as compared to traditional thoracotomy.