Transthoracic Removal of Pulmonary Artery Foreign Body by Percutaneous Balloon Occlusion

Removal of a foreign body in the pulmonary circulation is typically attempted by an endovascular approach as first attempt. The artery must be occluded either manually or with cardiopulmonary bypass during procedure. Here, we report case video-assisted thoracic surgery to remove from right under percutaneous balloon occlusion. For difficult cases, can retrieved (VATS) Intravenous catheterization often attempt circulation. In cases anticipated difficulty approach, operation conducted retrieve body. During operation, temporarily suspended closing off bypass. We here removal VATS A 67-year-old woman underwent lumbar spinal canal decompression. interbody fusion cage (20 × 11 9 mm; Figure A) was accidentally dislodged into inferior vena cava. Intraoperative fluoroscopy showed migration artery, but there were no signs indicative embolism. completed planned. Computed tomography chest confirmed middle trunk well some thrombosis proximal (Figure B). Retrieval postponed until 8 days later because use anticoagulants and high risk bleeding. Owing size shape cage, technical did not it intravenous catheterization. Instead, designed plan Briefly, general anesthesia double-lumen endotracheal intubation. port seventh intercostal space at midaxillary line, observation fifth line. catheter placed main guidance digital subtraction angiography. After visualized fluoroscopy, inflated. region vein exposed relative ease deep lung fissure this patient. longitudinal incision made neural probe used extract thromboemboli. closed 4-0 Prolene suture, deflated (Video). Fluoroscopy revealed complete patency closed. lasted for 190 minutes, total occlusion time approximately 20 minutes. patient received routine anticoagulation therapy 2 discharged 1 week later. At 1-month follow-up, computed angiography stenosis thrombosis. most successfully nonsurgical approach.1Pelage J.P. El Hajjam M. Lagrange C. et al.Pulmonary interventions: overview.Radiographics. 2005; 25: 1653-1667Crossref PubMed Scopus (57) Google Scholar Because its position short course, thoracotomy that require (eg, large heavy smooth surface). Cardiopulmonary alternative associated variety complications.1Pelage This describes successful artery. advantages include less traumatic injury vs thoracotomy, avoiding complications bypass, prevention possible operation. Video viewed online version article [https://doi.org/10.1016/j.atssr.2023.02.015] on http://www.annalsthoracicsurgery.org. authors have funding sources disclose.