Successful Treatment of Multiple Systemic Artery–to–Pulmonary Artery Fistulas

Systemic artery–to–pulmonary artery fistula (SAPAF) is an uncommon abnormal vascular connection between systemic and pulmonary arteries. SAPAF with 3 or more inflow vessels has rarely been reported. The definitive diagnosis is made by selective arterial angiography, but 3-dimensional computed tomography angiography is useful for delineating abnormal vessels. Embolization is currently performed as a less invasive treatment option, but surgical treatment remains an essential treatment option for preventing recurrence, especially in cases with many abnormal vessels. Herein, we report a case of successful treatment of SAPAF by sparing the lung parenchyma through abnormal inflow vessel dissection and peripheral lung abnormal tissue resection.