Pulmonary artery aneurysm embolization (How to remove the glue cast which migrated into unwanted vessel)
A 72-year-old female patient with chronic inflammation due to NTM developed a systemic to pulmonary shunt in the left lung, for which bronchial artery embolization was performed.
While successfully occluding the bronchial artery, a pulmonary artery aneurysm was identified on CT imaging.
It was planned to proceed with pulmonary artery aneurysm embolization if hemoptysis were to recur in the short term.
Following bronchial artery embolization (BAE), hemoptysis recurred within a day, prompting a request for a repeat procedure.
In the pulmonary artery angiography conducted using a pigtail catheter, the parenchyma of the left upper lobe (LUL) did not opacify.
The professor(operator) explained that this was likely due to the presence of flow from the bronchial artery, causing a shunt and preventing visualization.
Arch aortography was performed to assess bronchial artery supply, but no significant findings were observed.
Given the difficulty in accessing the bronchial artery due to the recent bronchial artery embolization conducted a day prior, it was decided to proceed with the procedure by accessing the pulmonary artery.
When performing angiography using a Davis catheter to select the pulmonary artery supplying the left upper lobe (LUL), a lesion suspected to be the pulmonary artery aneurysm seen on CT was identified.
Line : Glue cast attached to Davis catheter (5Fr, 90cm)
The lesion was subsequently embolized with a glue-lipiodol mixture (1:3)
The embolization procedure was successful; however, upon removing the microcatheter, it was observed that a glue cast had adhered to the Davis catheter.
Arrow : embolized pulmonary artery aneurysm.
Line : Glue cast attached to Davis catheter (5Fr, 90cm)
An attempt was made to insert the Davis catheter into a sheath for removal along with the glue cast.
However, the glue cast detached from the Davis catheter and migrated into the left lower lobar pulmonary artery.
So, a Davis catheter and a 0.035″ Terumo GW were used to select the pulmonary artery containing the glue cast.
The Davis catheter was advanced as close to the glue cast as possible, and an attempt was made to remove the glue cast using a Snare catheter.
While the Snare catheter successfully grasped a portion of the glue cast, it was larger in size compared to the Snare catheter, leading to partial removal with the remainder migrating once again.
So, a larger-sized snare was attempted for a second time, without the use of a snare catheter, by directly inserting it into the Davis catheter to grasp the glue cast.
The attempt was successful in capturing the glue with the Davis catheter and snare.
However, when attempting to remove it through the sheath, it was observed that the glue cast was larger than the sheath, preventing it from passing through.
As a result, it was decided to remove the glue cast, snare, Davis catheter, and guiding sheath as a single unit, which proved successful.
Today, we had a successful case of extracting the glue cast.
It was a critical moment with a risk of losing a portion of the patient’s lung tissue.
Fortunately, we were able to successfully remove the glue cast, avoiding any such complications.
Related posts:
