Endovascular Treatment of Symptomatic Pulmonary Sequestration Leopoldo M. Marine, Francisco E. Valdes, Renato M. Mertens, Michel R. Bergoeing, and Albrecht Kramer, Santiago, Chile Pulmonary sequestration is a rare congenital malformation whose origin is bronchial and arterial simultaneously and its vascularization comes from an anomalous systemic artery. Its clinical presentation includes recurrent pneumopathy in the same anatomic location of the lung and diffi- cult to resolve or recurrent lung abscess. It is usually treated with antibiotherapy and eventual surgical resection. A 23-year-old woman with history of recurrent respiratory infections and three episodes of hemoptysis was admitted at the hospital. Computed tomography and magnetic reso- nance imaging confirmed diagnosis of pulmonary sequestration. The angiographic study showed the presence of three inflow arteries arising from the thoracic aorta (T10) and supplying the abnormal lung parenchyma at the base of the left hemithorax. The patient underwent endo- vascular treatment consisting of exclusion of the inflow vessels with Amplatzer occlusive devices and coils. Subsequent computed tomography angiogram confirmed complete infarction of the sequestration. At 7 months, the patient presented with a new episode of bronchial infection. Repeated angiography showed persistence of intermediate small nutrient branches that were treated with coil embolization. The patient is symptom-free at 41 months after this secondary procedure. Endovascular treatment of pulmonary sequestration, with selective embolization of the inflow arteries, is a very attractive minimally invasive therapeutic option, as compared with conventional surgery, and potentially less prone to associated complications. Normal pulmonary parenchyma has a dual blood supply that comes from two sources: the first origin is the pulmonary artery and the second involves the bronchial arteries directly arising from the aorta. Both sources are connected at the level of the respi- ratory bronchioles, where pulmonary and bronchial capillaries freely anastomose. An abnormal communication between the pul- monary and systemic circulations may appear as a result of either congenital or acquired pathologies; most notably, the former include pulmonary sequestration. This is a rare congenital malformation whose origin is bronchial and arterial simultaneously. It consists of an abnormal pulmonary tissue that has no identifiable connection with the bronchial tree. Its blood supply comes exclusively from one or more anomalous systemic arteries rather than the pulmonary circulation. 1 Its clinical manifestations are recurrent pneumopathy in the same anatomical location. It is usually difficult to be solved, and occa- sionally presents complications such as recurrent pulmonary abscess or hemoptysis. It is usually treated with antibiotherapy and surgical resection. 2 We describe the case of a patient with symptom- atic pulmonary sequestration treated with selective embolization of the inflow arteries and its subse- quent course. CLINICAL CASE History and Clinical Presentation A 23-year-old woman, without a history of congen- ital or pediatric diseases, was admitted at the hospital because of a 2-month history of purulent sputum and left chest pain, including three recent episodes Divisi on de Cirugı´a, Departamento de Cirugı´a Vascular y Endovas- cular, Pontificia, Universidad Cat olica de Chile, Santiago, Chile. Correspondence to: Leopoldo M. Marine, Profesor Asistente, Divisi on de Cirugı´a, Pontificia, Departamento de Cirugı´a Vascular y Endovascu- lar, Universidad Cat olica de Chile, Apoquindo 3990, Oficina 601 - Las Condes, Santiago, Chile, E-mail: marinepolo@yahoo.com Ann Vasc Surg 2011; 25: 696.e11-696.e15 DOI: 10.1016/j.avsg.2010.08.012 Ó Annals of Vascular Surgery Inc. 696.e11