Preoperative embolization of dual arterial supply in extralobar pulmonary sequestration: a case report and literature review

Pulmonary sequestration (PS) is the second most common pulmonary congenital malformation, which involves non-functional lung tissue that lacks communication with the tracheobronchial tree and is supplied by aberrant systemic arteries, with venous drainage to either the pulmonary or systemic venous system. This anatomic malformation increases patients' risk of recurrent infection due to the lack of robust gas exchange. Hence, prompt intervention is warranted for favourable outcomes. Surgical resection is the gold standard treatment for PS. However, embolization of aberrant arteries prior to surgery is a promising adjunct to reduce the risk of intraoperative hemorrhage associated with the aberrant arterial supply. Here we report a case of a 47-year-old man with suspected symptomatic extralobar sequestration dual feeders from a subclavian common trunk with an anomalous pulmonary arterial connection. The patient underwent preoperative embolization of feeding and draining vessels using low-profile plug occluders. The patient tolerated embolization and surgical resection with < 50 ml blood loss. Two-month post-operative imaging demonstrated the stable position of plug occluders. This case highlights the role of preoperative embolization with low-profile plug occluders as a safe and effective strategy for achieving hemodynamic control and minimizing intraoperative bleeding risk in anatomically complex pulmonary sequestrations.