Successful treatment of multiple systemic artery-to-pulmonary artery fistula

Systemic artery-to-pulmonary artery fistula (SAPAF) is an uncommon abnormal vascular connection between systemic and pulmonary arteries. SAPAF with three or more inflow vessels has been rarely reported. The definitive diagnosis is selective arterial angiography, but three-dimensional computed tomography angiography (3D-CTA) is useful for delineating abnormal vessels. Embolization has been currently performed as a less-invasive treatment option, but surgery 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 via abnormal inflow vessel dissection and peripheral lung abnormal tissue resection.