N-Butyl cyanoacrylate embolization of an extremely rare variant of sequestration complex - a high-flow left-to-left shunt between systemic artery and pulmonary vein

Abstract

A 19-year-old female presented with hemoptysis. Computed tomography (CT) pulmonary angiography revealed aberrant vessels from descending thoracic aorta, draining into pulmonary veins (left-to-left shunt). She was managed by transcatheter embolization of the aberrant vessels using N-butyl cyanoacrylate (NBCA) with balloon occlusion. A systemic artery to pulmonary vein fistula is one of the least common congenital anomalies. Most of the reported cases have been managed by surgery. Only a few patients have been treated by transcatheter embolization, using coils or vascular plugs as the embolizing agents. To our knowledge, this is the first case of its kind that was managed by glue embolization. Favorable post-procedure results have led us to believe that glue embolization can be considered a suitable alternative to thoracotomy in such patients.

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-023-01659-5.

Keywords: Bronchopulmonary sequestration; Butyl 2-cyanacrylate; Therapeutic embolization.

Fig. 1

Left-to-left shunt with failed coil embolization. A Angiogram (late arterial phase) after selective cannulation of D6 aberrant artery showing lung parenchymal blush. B Angiogram (venous phase) showing venous drainage into pulmonary vein and left atrium. C Persistent shunting despite multiple coil deployment on delayed contrast injection

Fig. 2

Glue embolization of the aberrant artery. A Assembly of microcatheter in distal position and monorail balloon catheter in proximal position with inflated balloon and contrast injection showing significant decrease in the blood flow. B Glue embolization performed using mixture of NBCA and lipiodol (1:1). C Post-embolization angiogram revealing complete embolization of the aberrant vessel