Staged Preoperative Embolization Followed by ICG-Guided Parenchyma-Sparing Resection of Pulmonary Sequestration: A...

Pulmonary sequestration is a rare congenital malformation supplied by an aberrant systemic artery, making parenchyma-sparing resection technically challenging because safe vascular control and accurate identification of the resection plane are both required. Indocyanine green (ICG) fluorescence has been used to delineate the perfusion boundary between sequestrated and normal lung, whereas preoperative embolization has traditionally been performed to reduce the risk of intraoperative bleeding. We describe a staged approach in which selective coil embolization of the aberrant feeding artery, performed one day before surgery, was followed by video-assisted fluorescence-guided wedge resection. Preoperative embolization established devascularization before surgery, while subsequent ICG fluorescence provided clear real-time delineation of the perfusion boundary, enabling tailored parenchyma-sparing resection. Although this observation derives from a single case and does not support routine preoperative embolization, it raises the hypothesis that the interval between embolization and surgery may influence the physiological conditions under which subsequent fluorescence-guided perfusion assessment is performed. This potential effect requires confirmation through quantitative fluorescence assessment and comparative studies.