VASCULAR PLUG EMBOLIZATION OF TWO ARTERIES OF PULMONARY SEQUESTRATION PRIOR TO LOBECTOMY

Öz

A 40-year-old male patient was admitted to our emergency department with hemoptysis. A contrast-enhanced thoracic computed tomography demonstrated pulmonary sequestration supplied by two separate aberrant arteries. Due to the risk of excessive bleeding during elective surgery, transcatheter embolization of aberrant arteries was planned before the operation. A 10mm Amplatzer Vascular Plug 2 was deployed to the proximal and a 6mm Amplatzer Vascular Plug 1 was deployed to the distal artery via the right femoral artery. The procedure was terminated with successful vascular embolization of the two afore-mentioned arteries. One month after the embolization, the robotic left lower lobectomy was performed electively.

Anahtar Kelimeler

• Pulmonary sequestration,robotic lobectomy,vascular plugs

LOBEKTOMİ ÖNCESİ PULMONER SEKESTRASYONUN VASKÜLER PLAK EMBOLİZASYONU

Öz

40 yaşında bilinen sistemik hastalık öyküsü olmayan hemoptizi şikayeti ile acil servisimize başvuran hastanın çekilen kontrastlı toraks BT’sinde sol alt akciğer parenkiminin torasik aortadan kaynaklı iki aberran arter ile kanlandığı saptanmıştır. Göğüs cerrahisi tarafından değerlendirilerek lobektomi planlanan hastanın peroperatif kanama riskini azaltmak için elektif cerrahi öncesi aberran arterlerin transkataterik kapatılması planlandı. Sağ femoral yolla yapılan anjiografi sonrası proksimal artere 10 mm Amplatzer Vasküler Plak 2, distal artere ise 6 mm Amplatzer Vasküler Plak 1 yerleştirilerek işlem başarı ile sonlandırıldı. Hastaya 1 ay sonra elektif olarak başarılı robotik lobektomi uygulandı. Bu hibrid yaklaşım nadir bir tedavi stratejisi olarak uygulanmıştır.

Anahtar Kelimeler

• Pulmoner sekestrasyon,robotik lobektomi,vasküler plak

Kaynakça

1. 1. Yucel O, Gurkok S, Gozubuyuk A, Caylak H, Sapmaz E, Kavakli K, et al. Diagnosis and surgical treatment of pulmonary sequestration. Thorac Cardiovasc Surg 2008;56(3):154-57.
2. 2. Ganeshan A. Freedman J, Hoey ET, Steyn R, Henderson J, Crowe PM. Transcatheter coil embolization: a novel definitive treatment option for intralobar pulmonary sequestration. Heart Lung Circ 2010;19(9):561-5.
3. 3. Felker RE, Tonkin IL. Imaging of pulmonary sequestration.  AJR Am J Roentgenol 1990;154(2):241-9.
4. 4. Savic B, Birtel FJ, Tholen W, Funke HD, Knoche R. Lung sequestration: Report of seven cases and review of 540 published cases. Thorax 1979;34(1):96-101.
5. 5. Yong W, Fan L. Pulmonary sequestration: a retrospective analysis of 2625 cases in China. Eur J Cardiothorac Surg 2011;40(1):39-42.
6. 6. Tokel K, Boyvat F, Varan B. Coil embolization of pulmonary sequestration in two infants; a safe alternative to surgery. AJR Am J Roentgenol 2000;175(4):993-5.