Hybrid surgery in treatment of pulmonary sequestration with abdominal aorta feeding vessel: a case report

Abstract

BackgroundPulmonary sequestration is a rare congenital pulmonary dysplasia, which requires surgical resection (either via open thoracotomy or video-assisted thoracoscopic surgery [VATS] or via endoluminal occlusion of the abnormal feeding vessel).Case presentationWe described a 51-year-old female patient with a history of recurrent cough and repeated pneumonia. She was referred to our hospital for further work-up of pulmonary sequestration. We performed a hybrid surgery (i.e., embolization of the aberrant feeding vessel of the sequestration combined with wedge resection of the left lower lobe lesion through VATS). The patient was discharged on the sixth postoperative day in good condition and without complications.ConclusionsWe believe that a hybrid operation is safer, more feasible, and more comprehensive than other treatments.

Lessons learned from hybrid surgery with preoperative coil embolization for an aberrant artery in pulmonary sequestration

“…Thus, in patients who undergo surgery for PS, the appropriate and safe management of an aberrant artery is the most important factor considered by thoracic surgeons. With the development of endovascular techniques, several reports have shown that preoperative coil embolization is effective in decreasing the risk of serious intraoperative hemorrhage [3][4][5][6][7]. However, challenges associated with the procedure, similar to those observed in the current case, have not been discussed in previous studies.…”

“…However, the optimal management of an aberrant artery is controversial. Several studies have shown that hybrid surgery with preoperative coil embolization for an aberrant artery can effectively reduce the risk of serious intraoperative hemorrhage [3][4][5][6][7]. However, there are no clear indications for the procedure.…”

Endovascular treatment of a right pulmonary sequestration supplied by an aneurysmal aberrant artery originating from the abdominal aorta

“…The arteries feeding the PS have some particularities that pose a challenge for treatment: they carry blood under systemic pressure, in a fragile, thin-walled artery, which can lead to accelerated atherosclerotic changes and is more susceptible to damage from recurrent pulmonary infections or tear injuries. 4 , 6 , 7 In addition, inflammatory changes associated with recurrent PS infections distort the normal anatomy and can make open surgery very difficult.…”

“… 1 The potential risks of massive hemorrhage or retraction into the abdomen make it advisable to completely resect the sequestration artery from its abdominal origin, requiring addition of laparotomy, lengthening the duration of surgery, or addition of embolization of its origin prior to pulmonary resection. 6 , 7…”

Video‐assisted thoracoscopic right lower lobectomy for pulmonary sequestration supplied by a large feeding vessel from the abdominal aorta

“…Other congenital pulmonary malformations are sometimes associated with PS, possibly increasing the risk of carcinogenesis. In most cases, PS is diagnosed during childhood or adolescence but occasionally diagnosis can be delayed until adult age, when clinical presentation ranges from asymptomatic to, more often, recurrent chest infections and severe haemoptysis 2,3 …”