A Case of Successful Transcatheter Coil Embolization of Multiple Systemic Arteries-to-Pulmonary Artery Fistulas

Pulmonary vascular malformations include pulmonary arteriovenous fistula, systemic artery-to-pulmonary artery fistula (SAPAF), and systemic artery-to-pulmonary vein fistula. In particular, systemic artery-to-pulmonary artery fistulas with three or more inflow vessels are rare. Herein, we report a case of successful transcatheter coil embolization for multiple SAPAFs. Three-dimensional computed tomography (3D-CT) and selective angiography revealed that the right inferior phrenic artery, right internal thoracic artery, and two right bronchial arteries were visualized and flowing into the right lower pulmonary artery through a 3 cm aneurysm. Under X-ray fluoroscopy guidance, a microcatheter was inserted into the aneurysm from the side of the main pulmonary artery, and the inflow arteries were embolized with coils. Subsequently, the interior of the aneurysm was embolized using coils. Follow-up angiography was performed six months postoperatively. Shunts between all systemic arteries and pulmonary arteries disappeared completely, and the small aneurysm was confirmed to have decreased in size. In this case, when a lung resection is performed, a large aneurysm is present, and vascular handling is expected to be challenging, so transcatheter arterial embolization is considered a minimally invasive and highly effective treatment.