Iatrogenic pulmonary artery perforation associated with 5-Fr catheter manipulation during pulmonary arteriovenous malformation embolization with a vascular plug

Vascular plugs have been increasingly used because they have lower recanalization rates than coil embolization in pulmonary arteriovenous malformation (PAVM) embolization. To deliver the vascular plug close to the PAVM, a large-diameter catheter should be advanced into the feeding pulmonary artery, which carries a risk of vascular damage. Fifty-three-year-old women was admitted to our hospital for embolization of a single PAVM. Pulmonary angiography revealed a simple PAVM with a tortuous, small feeding artery in the right middle lobe, and feeding artery negotiation was attempted using a 5-Fr headhunter-type catheter to deliver the vascular plug. However, unintentional arterial perforation occurred suddenly when the guide wire was withdrawn after the catheter was advanced to the feeding artery adjacent to the sac. Immediate embolization using a vascular plug and microcoils at the proximal site of the perforation was performed to stop both PAVM shunt flow and bleeding. To prevent such a catheter-induced complication, it is necessary to select a diagnostic catheter with appropriate stiffness and angle and to switch to a small-diameter delivery system depending on the situation.