Lungs and Pleura

Vena caval filters for prevention of pulmonary embolism

“…Retrievable filters have variable retrieval rates as reported in the literature, from 22% (Karmy-Jones 2007) to between 88% and 100% (Imberti 2005). The true rate of filter retrieval is not known as these figures are likely to reflect publication bias.…”

“…In addition, the PREPIC study used permanent filters. There is an increasing trend towards the use of retrievable filters in practice, although it would seem many of these are left in situ (Karmy-Jones 2007). The PREPIC study also lacked statistical power to detect a reduction in the incidence of pulmonary embolism over shorter and more clinically significant time periods.…”

Treatment for unstable pulmonary sequestration injury in patient with severe blunt trauma: A case report

“…First, drainage, suturing, and/or wedge resection may not be sufficient to control bleeding from pulmonary sequestration. Almost 85% of patients with blunt thoracic trauma are managed using conservative approaches, such as drainage, and only 2% of these patients require surgical intervention and/or endovascular arterial embolization; [3] this is due to the low tension in the pulmonary circulation that can terminate the bleeding if hemorrhage is drained from the visceral pleural contact to the parietal pleura [4] . However, the sequestered tissue of pulmonary sequestration is supplied by a systemic blood artery which has a blood pressure is higher than that of the normal pulmonary artery [1] .…”

“…Feeding arteries, usually one or two in number, arise from the descending thoracic aorta in 73% of pulmonary sequestration cases. Although less common, subclavian, splenic, or right coronary artery can also be the origin of a feeding artery [3] , [7] . Due to the variability in the number and origin of feeding arteries among patients, identification of all aberrant feeding arteries by CT or/and angiography is necessary before surgical intervention.…”

“…Moreover, surgical resection is generally indicated for all patients with pulmonary sequestration due to the potential risk of severe recurrent infections, massive hemorrhage, and congestive heart failure caused by left-sided cardiac overload [5] , suggesting that it may not be necessary to consider possible complications of complete occlusion of the arterial supply [8] . Recently, endovascular embolization of pulmonary sequestration via embolization of the proximal feeding artery has been reported as a safe alternative to surgery [3] , [6] , [8] , [9] . We did not perform embolization of the feeding artery in this case as extravasation was not observed during emergent selective angiography of the feeding artery; however, similar to other cases with hemorrhage due to pulmonary sequestration, proximal embolization of the feeding artery should be performed regardless of the presence or absence of extravasation by selective angiography of the feeding artery.…”