Trancatheter embolization of pulmonary artery pseudoaneurysm with detachable coils in association with non-adhesive liquid embolizing agent (Squid). Rare pulmonary artery lesion: innovative approach.

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Filippo Piacentino https://orcid.org/0000-0002-0756-9967
Federico Fontana https://orcid.org/0000-0002-3809-5696
Marco Curti https://orcid.org/0000-0002-0903-6558
Andrea Imperatori https://orcid.org/0000-0001-6281-1800
Massimo Venturini https://orcid.org/0000-0003-2983-8328

Keywords

aneurysm, angiography, CT angiography, embolization, interventional

Abstract

A nodular lesion at the lower left pulmonary lobe was detected in a 46 years old male during a preoperative chest X-Ray for appendicitis. To further characterise the nodule, a contrast enhanced computed tomography (CE-CT) was performed (Fig 1a, 1b) showing a 20 mm vascular lesion, which was suspected to be a pseudoaneurysm.


While investigating the patient's history, it was found that he had previously suffered from an atrioventricular block which was treated with a temporary pacemaker positioned through a femoral access; subsequently a permanent pacemaker was placed with no complications reported during follow ups.


The diagnostic angiography detected a flattening of the vascular wall with a voluminous pseudoaneurysm in the distal portion of the tributary branch. To treat the lesion, a 2.9F microcatheter was advanced into the sac and 4 detachable coils were placed (16-18mm Penumbra Inc). To block vascular supply to the lesion, the feeding artery was embolized with an ethylene vinyl alcohol copolymer agent (Squid Peri 18, Emboflu). The Squid was slowly injected within 30 seconds and when it started flowing back into the proximal region of the feeding vessel, the microcatheter was pulled out (Fig 2 c).


The final angiographic control showed the exclusion of the pseudoaneurysmal sac which was confirmed by SEMAR™ reconstructed CE-CT scan after 40 days (Fig 1 c - Fig 2 c). Furthermore, no signs of pulmonary infarction were found.

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References

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