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Endovascular Treatment of a Systemic-to-Pulmonary Artery Fistula: A Case Report

체-폐동맥루의 혈관 내 치료: 증례 보고

  • Eunbyul Lee (Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Dong Jae Shim (Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Doyoung Kim (Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jung Whee Lee (Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 이은별 (가톨릭대학교 의과대학 인천성모병원 영상의학과) ;
  • 심동재 (가톨릭대학교 의과대학 인천성모병원 영상의학과) ;
  • 김도영 (가톨릭대학교 의과대학 인천성모병원 영상의학과) ;
  • 이정휘 (가톨릭대학교 의과대학 인천성모병원 영상의학과)
  • Received : 2020.05.22
  • Accepted : 2020.08.02
  • Published : 2021.05.01

Abstract

Systemic-to-pulmonary artery fistulas are rare. This condition may be congenital, post-traumatic, or post-inflammatory and can cause infection, hemorrhage, or pulmonary hypertension. Here, we report a case of an intercostal-to-pulmonary artery fistula, incidentally detected during the evaluation of dyspnea in a 67-year-old female. Retrograde transcatheter coil embolization in a dilated draining pulmonary artery was initially attempted. However, another draining pulmonary artery developed after 5 months. The intercostal arteries or systemic feeders were successfully embolized through a transarterial access. At the 10-month follow-up, the abnormally dilated vessels had regressed, and dyspnea had improved. Sequential or simultaneous retro- and antegrade transcatheter embolization may successfully treat pleural arterio-arterial fistulas.

체-폐동맥루는 주로 외상, 감염, 종양 등에 의해 유발될 수 있으나 위험 인자가 없는 환자에서 생기는 체-폐동맥루는 매우 드물다. 이들은 감염이나 출혈 혹은 폐 고혈압 등을 유발할 수 있어 치료가 필요하다. 호흡곤란을 주소로 내원한 67세 여자 환자에서 늑간동맥-폐동맥루가 발견되었다. 먼저 배출혈관인 확장된 폐동맥으로 역행성으로 접근하여 코일 색전술로 치료하였으나 5개월 후 인접폐동맥의 확장이 관찰되어 공급동맥인 늑간동맥을 N-butyl cyanoacrylate를 이용하여 색전하였다. 10개월 추적검사에서 환자의 증상과 확장된 폐동맥은 호전되었다. 체-폐동맥루를 치료에서 순차적 혹은 동시에 역방향과 순방향 접근으로 혈관 내 치료하는 것이 효과적일 수 있겠다.

Keywords

References

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