Endovascular embolisation strategies for pulmonary arteriovenous malformations

Abstract

PurposeTo assess the immediate efficacy of distinct embolisation devices in the endovascular treatment of pulmonary arteriovenous malformations as well as to identify and analyse the possible determinants of the technical success of the procedure.Material and methodsProspective analysis of 16 consecutive patients was carried out, who underwent transcatheter endovascular embolisation therapy for pulmonary arteriovenous malformations between 2005 and 2017. Pre- and post-procedural angiography studies were implemented to confirm the diagnosis and to evaluate the technical success defined as the complete occlusion of the feeding artery. Embolisation devices – coils, microcoils, occluders, or combination of the above – were used. All the patients were advised to conduct a follow-up computed tomography evaluation 12 months after the procedure.ResultsA total of 40 pulmonary arteriovenous malformations (PAVMs) were observed and embolised. The immediate technical success was achieved in all (n = 40; 100%) treated PAVMs, as confirmed by the post-procedural angiographic result. The statistical analysis revealed no significant impact of the number of PAVMs per patient (p > 0.05), their angioarchitecture (p > 0.05), localisation within the lung (p > 0.05) or particular lobe (p > 0.05), and the selection of embolisation device (p > 0.05) on the procedural success rates. The procedure-related complication rate was equal to 6.25%.ConclusionsThe immediate success rate of the transcatheter PAVM embolisation reached 100% in this study. The statistical model of logistic regression revealed no significant impact of the number of PAVMs per patient, their angioarchitecture, localisation, and distribution pattern, as well as device selection, on the immediate technical success of the procedure.

Endovascular management of pulmonary arteriovenous malformations presenting as multiple brain abscesses

“…These symptoms are the result of significant right-to-left shunting leading to chronically reduced blood oxygenation and persistent hypoxaemia 4 6. Though the patients may remain asymptomatic for long duration, severe neurological events such as transient cerebral ischaemia, stroke and brain abscesses occur in approximately 6%–10% of untreated cases of PAVM 2 3 6–8. The risk of CNS complications becomes significant when the feeding pulmonary artery is >3 mm in diameter 2–4 7 9…”

The Role of Interventional Radiology in the Diagnosis and Treatment of Pulmonary Arteriovenous Malformations

“…One solution would be to use a combination of vascular plugs and embolization coils to pack the nidus. This has been shown to reduce reperfusion rates as compared to vascular plug use alone [ 5 ].…”

“…Reperfusion was most commonly a result of the recanalization of the embolized artery. The second most common cause was the development of accessory vessels (up to 38%) [ 5 ]. Milic et.al.…”

“…Post-procedure, the most common early complications are pleuritic chest pain [ 18 ] and blood-stained sputum. These are usually self-limiting [ 5 ].…”

“…PAVMs affect as many as 1 in 2600 individuals [ 3 , 4 ], with a female-to-male ratio of 1.67:1 [ 5 ]. Approximately 80% of PAVMs are associated with hereditary hemorrhagic telangiectasia (HHT).…”