Recanalization after coil embolotherapy of pulmonary arteriovenous malformations: study of long-term outcome and mechanism for recanalization.

Sagara, K; Miyazono, Nobuaki; Inoue, Hirofumi; Ueno, Kazuhiro; Nishida, Hitoshi; Nakajo, Masayuki

doi:10.2214/ajr.170.3.9490963

Cited by 115 publications

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“…The reason this question is important is that for individuals with pulmonary AVMs, embolisation is an effective means of reducing lifetime risks of paradoxical embolic stroke and brain abscess [1,2], improving oxygenation [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] and treating pulmonary AVM-related haemoptysis [18,19]. Conversely, embolisation may be expected to elevate pulmonary artery pressure (Ppa), since pulmonary AVMs are abnormal dilated vessels between pulmonary arteries and veins that provide low resistance pathways for pulmonary blood flow [20].…”

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confidence: 99%

“…Out of .700 reported pulmonary AVM embolisations [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][34][35][36][37][38][39][40][41][42], data on Ppa measurements pre-and post-embolisation are scarce [9,11,17,32]. In three out of the four reported cases [9,17,32], each selected from larger series, Ppa increased postembolisation, while in the fourth it was unchanged [11].…”

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confidence: 99%

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Embolisation of pulmonary arteriovenous malformations: no consistent effect on pulmonary artery pressure

Shovlin¹,

Tighe²,

Davies³

et al. 2008

Eur Respir J

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Increasing evidence supports the use of embolisation to treat pulmonary arteriovenous malformations (AVMs). Most pulmonary AVM patients have hereditary haemorrhagic telangiectasia (HHT), a condition that may be associated with pulmonary hypertension.The current authors tested whether pulmonary AVM embolisation increases pulmonary artery pressure (Ppa) in patients without baseline severe pulmonary hypertension. Ppa was measured at the time of pulmonary AVM embolisation in 143 individuals, 131 (92%) of whom had underlying HHT. Angiography/embolisation was not performed in four individuals with severe pulmonary hypertension, whose systemic arterial oxygen saturation exceeded levels usually associated with dyspnoea in pulmonary AVM patients.In 143 patients undergoing pulmonary AVM embolisation, Ppa was significantly correlated with age, with the most significant increase occurring in the upper quartile (aged .58 yrs). In 43 patients with repeated measurements, there was no significant increase in Ppa as a result of embolisation. In half, embolisation led to a fall in Ppa. The maximum rise in mean Ppa was 8 mmHg: balloon test occlusion was performed in one of these individuals, and did not predict the subsequent rise in Ppa following definitive embolisation of the pulmonary AVMs.In the present series of patients, which excluded those with severe pulmonary hypertension, pulmonary artery pressure was not increased significantly by pulmonary arteriovenous malformation embolisation.KEYWORDS: Brain abscess, hypoxaemia, nosebleeds, oxygen saturation, right-to-left shunt, stroke D oes embolisation of pulmonary arteriovenous malformations (AVMs) precipitate pulmonary hypertension (PH)? The reason this question is important is that for individuals with pulmonary AVMs, embolisation is an effective means of reducing lifetime risks of paradoxical embolic stroke and brain abscess [1,2], improving oxygenation [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] and treating pulmonary AVM-related haemoptysis [18,19]. Conversely, embolisation may be expected to elevate pulmonary artery pressure (Ppa), since pulmonary AVMs are abnormal dilated vessels between pulmonary arteries and veins that provide low resistance pathways for pulmonary blood flow [20].The question of whether pulmonary AVM embolisation increases Ppa is particularly pertinent, since most individuals with pulmonary AVMs have underlying hereditary haemorrhagic telangiectasia (HHT). Typically recognised by nosebleeds, mucocutaneous telangiectasia and visceral AVMs [21], HHT may be associated with PH [9,[22][23][24][25][26][27][28][29][30]. The secondary causes of PH in HHT are diverse, as they are in the normal population [31], but PH particularly occurs either as a true pulmonary arterial hypertension (PAH) phenotype [9,22,[28][29][30] or in the context of high output cardiac failure secondary to hepatic AVMs, when PH may be reversible after hepatic AVM treatment [32]. The frequencies of PAH and hepatic AVMs differ with HHT genotype: HHT is caused by mutatio...

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confidence: 99%

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confidence: 99%

Embolisation of pulmonary arteriovenous malformations: no consistent effect on pulmonary artery pressure

Shovlin¹,

Tighe²,

Davies³

et al. 2008

Eur Respir J

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“…Persistence can result from recanalization of the occluded vessels through the previously placed embolic material; interval reperfusion through accessory vessels from the pulmonary or systemic circulation; or incomplete primary treatment, especially in complex PAVMs (2,(8)(9)(10). Recanalization of the occluded feeding artery is considered as the most common cause of persistence of PAVM treated with coils, occurring in 88%-91% of these patients (1,(10)(11)(12). In our study, persistence occurred in one PAVM, yielding a rate of 3%.…”

Section: Discussionmentioning

confidence: 55%

Persistence of pulmonary arteriovenous malformations after successful embolotherapy with Amplatzer vascular plug: long-term results

Aal¹,

Ibrahim²,

Moustafa³

et al. 2016

Diagn Interv Radiol

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“…However, one of the advantages of TAE is the possibility of re-intervention for recanalization after long-term follow-up. Regarding the TAE treatment in this case, embolization of the feeding artery alone was judged as inadequate because the pulmonary artery could potentially have some communicating vessels, including the bronchial artery in some cases [8].…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Microcoil Embolization of an Idiopathic Solitary Pulmonary Artery Aneurysm

Iwamoto

Kinoshita

Miyamoto

et al. 2017

Interventional Radiology

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An incidental vascular abnormality was identified in a female patient in her 70s with a history of malignant lymphoma. Contrast-enhanced computed tomography (CT) scans revealed a pulmonary artery aneurysm (PAA) originating at the A10 branch of the right pulmonary artery (10 9 9 mm in size), which involved three distal branches at the aneurysmal sac. Retrospectively, this PAA was identified on CT images two years prior, and has been growing since. Endovascular embolization was performed with microcoils that were placed in the aneurysmal sac and the distal and proximal sites of the parent artery, achieving complete resolution of the PAA without complications. Coil embolization can be one of the treatment options in management of the unruptured PAA, although further investigations are necessary.

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Recanalization after coil embolotherapy of pulmonary arteriovenous malformations: study of long-term outcome and mechanism for recanalization.

Cited by 115 publications

References 0 publications

Embolisation of pulmonary arteriovenous malformations: no consistent effect on pulmonary artery pressure

Embolisation of pulmonary arteriovenous malformations: no consistent effect on pulmonary artery pressure

Persistence of pulmonary arteriovenous malformations after successful embolotherapy with Amplatzer vascular plug: long-term results

Transcatheter Microcoil Embolization of an Idiopathic Solitary Pulmonary Artery Aneurysm

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