Iatrogenic Pulmonary Artery Perforation

Abstract Background: Vascular plugs have been increasingly used for lower recanalization compared with coil embolization in pulmonary arteriovenous malformation (PAVM) embolization. To deliver the vascular plug close to the PAVM, a large-diameter delivery catheter should be advanced into the feeding pulmonary artery. However, the pulmonary artery has a complex branching pattern and the risk of injury increases when a larger catheter is used in negotiating the PAVM feeder.Case Presentation: We describe a patient who developed pulmonary artery perforation during the selection of the distal feeding artery with a 5-Fr catheter in PAVM embolization. We immediately treated the PAVM and life-threatening complication by using a type IV vascular plug and coil embolization in a single session.Conclusion: To prevent catheter-related complications during PAVM embolization, a smaller diameter delivery system should be used for small, tortuous feeding arteries, and use of a soft, tip-angled catheter for vascular plug delivery should be considered.