PMC9550518_01
3-year-old patient. (
A
) Preoperative chest CT with contrast; white arrows (below): aberrant feeding artery coming from abdominal aorta, white arrows (up): venous return. (
B
) "Sub"-embolization with coil, correct timing for methylene blue injection into the aberrant artery. (
C
) Thoracoscopic view; white arrow: endoscopic injection needle placed in the embolized artery. (
D
) After electrocoagulation marking of the sequestration and before resection. CT, computed tomography.
10-1055-s-0042-1757570-i2021070618cr-1.jpg
PMC9550518_01_10-1055-s-0042-1757570-i2021070618cr-1.jpg
FI2021070618cr-1
The feeding artery was identified as originating from the abdominal aorta in the 3-year-old girl and from the celiac trunk in the 1-year-old girl ( Figs. 1 and 2 ).  Once the coils had been introduced, 10 mL of diluted methylene blue (1 ampoule of 10 mg/1 mL methylene blue diluted with physiologic serum) was injected within the artery ( Figs. 1 and 2 ). In our first patient we injected too late, and we had to reinject a small amount of methylene blue directly in the feeding vessel with an endoscopic needle to have sufficient coloration during the resection ( Fig. 1 ). We also performed electrocoagulation marking of the mass before the disappearance of the blue coloration due to preserved venous drainage ( Fig. 1 ).   After the endovascular step, we positioned the patient in left lateral decubitus and proceeded to resection of the mass by VATS, using the 3 mm Bolder sealer ( Figs. 1 and 2 ), 3 mm laparoscopic instruments, and a 5 mm 30  camera.
1-year-old patient. (
A
) Preoperative chest CT with contrast; white arrow: aberrant feeding artery coming from celiac trunk. (
B
) "Sub"-embolization with coil, correct timing for methylene blue injection into the aberrant artery. (
C
) Complete embolization with coil (no downstream blood flow). (
D
) Intraoperative view, blue coloration of the sequestration and clear demarcation of healthy tissue, before marking and resection. CT, computed tomography.
10-1055-s-0042-1757570-i2021070618cr-2.jpg
PMC9550518_01_10-1055-s-0042-1757570-i2021070618cr-2.jpg
FI2021070618cr-2
The feeding artery was identified as originating from the abdominal aorta in the 3-year-old girl and from the celiac trunk in the 1-year-old girl ( Figs. 1 and 2 ).  Once the coils had been introduced, 10 mL of diluted methylene blue (1 ampoule of 10 mg/1 mL methylene blue diluted with physiologic serum) was injected within the artery ( Figs. 1 and 2 ).  After the endovascular step, we positioned the patient in left lateral decubitus and proceeded to resection of the mass by VATS, using the 3 mm Bolder sealer ( Figs. 1 and 2 ), 3 mm laparoscopic instruments, and a 5 mm 30  camera.
PMC9550518_02