Coil Embolization for Pulmonary Arteriovenous Malformation as an Organ-sparing Therapy: Outcome of Long-term Follow-up

Abstract

Purpose: Pulmonary artery coil embolization (PACE) is increasingly utilized to treat pulmonary arteriovenous malformations (PAVMs), but the long-term outcome of this treatment modality remains unclear. By evaluating the long-term outcome of patients at St. Marianna University Hospital treated with PACE, we wanted to see if PACE could effectively replace the surgical resection of PAVMs. Patients and Methods: We retrospectively evaluated 9 consecutive patients (4 males, 5 females; age range, 16-67 years; mean ± SD, 43.6 ± 18.7 years) who underwent PACE for PAVMs. Selective pulmonary artery angiography using Seldinger's method was initially performed to identify the feeding arteries. This was followed by embolization using interlocking detachable coils and microcoils. Results: The procedure resulted in no severe complications. All treated patients were free from PAVM symptoms. A recurrence did not occur after PACE in 8 of 9 (88%) patients for 31 to 173 months (86 ± 51). Recanalization of the embolized malformation occurred after 3 months in one patient. This patient underwent an additional successful PACE without any further recurrences for 73 months. Conclusions: PACE is an organ-sparing therapy with satisfactory long-term results. It can safely replace the surgical resection of PAVMs.

The Role of Time-Resolved MRA for Post-treatment Assessment of Pulmonary Arteriovenous Malformations: A Pictorial Essay

“…The major treatment strategy for PAVM is coil embolotherapy [1,2]. Because the rates of recanalization of treated PAVMs are relatively high, periodic assessment of the patency of PAVMs is needed [3].…”

“…Because the loop of the feeding artery (open arrowhead) to the draining vein (solid arrowhead) ran horizontally, the scan slab could not include the right main branch of the pulmonary artery on TR-MRA (B, C). Nevertheless, it was able to detect the lesion and evaluate blood flow by referring to the enhancement of the contralateral pulmonary artery (high intensity at the ascending aorta was considered an inflow effect) (D)(1) To avoid overlap of normal vessels on MIP images, the number of slices per slab could be reduced as long as the targeted lesion and its feeding/draining vessels are included (2). The main branch of the PA, the aorta and the left atrium as well as the feeding/draining vessels should ideally be included in a slab; if this is not possible, the temporal phase could be estimated from contrast enhancement of other structures(Fig.…”

Late Presented Posttraumatic Pulmonary Arteriovenous Fistulea Occlusion With Septal Occluder Device

“…Küçük çaplı fistüllerde embolizasyon ile başarılı sonuçlar elde edilmektedir ancak lezyonun büyük ve santral yerleşimli olduğu olgularda cerrahi tedavi daha ön planda yer almaktadır. [19][20][21] Cerrahide yaklaşım, fistülün çapına göre basit fistül kapatılmasından lobektomiye kadar giden geniş bir yelpazede yer alır. [21,22] Transkateter yaklaşımda sıklıkla kullanılan basit 'coil' tipi tıkayıcılarla rekanalizasyon, migrasyon, trombüs gibi sorunlar bildirilmiştir.…”

The Value of İnterventional Radiology in Pulmonary Vascular Pathologies

“…Pulmoner arteriovenöz malformasyonlar (AVM), besleyici arter, venöz anevrizmal kese ve drenaj veninden oluşan yüksek debili ve düşük basınçlı vasküler bir patolojidir. Pulmoner AVM'lerin %80'i tek segmenter arterden kaynaklanan tek besleyici arter içerirken, %20'si kompleks olup, bunlar iki ya da daha fazla segmenter arterden birden fazla besleyici arter içerir (66) . Pulmoner AVM, pulmoner kapiller sirkülasyondaki filtrasyon kapasitesinin azalmasından dolayı, inme, geçici iskemik atak, beyin apsesi ve diğer sistemik enfeksiyonlarda önemli bir sebeptir (67) .…”