Transcatheter Coil Closure of Pulmonary Arteriovenous Malformations in Children

Abstract

Pulmonary arteriovenous fistula (PAVF) is a rare vascular malformation of the lung that may lead to cyanosis, epistaxis, hemoptysis, and neurological deficits or cerebral abscess. The purpose of this study is to assess the effectiveness of percutaneous transcatheter embolization of PAVF in pediatric patients. Transcatheter embolization of PAVF using spring coils was performed in three patients (two males and one female) who presented between 1989 and 1999. The age at presentation ranged from 8 months to 3 years (mean 19.6 months). All patients had cyanosis and clubbing. Neurological, dermatological, or other cardiac manifestations were absent. The arterial oxygen saturations at presentation ranged from 60 to 72% (mean 64%). During eight procedures, multiple coils (total of 41 coils, average 14 coils per patient) were delivered to occlude the fistulas successfully. There was complete occlusion of the fistulas in all patients after the multiple interventions. The aortic saturations increased from a mean of 66% to a mean of 95%. Chest radiographs demonstrated dramatic regression of the pulmonary shadows in all three patients. There were no complications encountered during the procedures or during follow-up. Transcatheter coil embolization of PAVF is a safe and effective method of treatment in the pediatric age group. Patients may require multiple procedures to completely occlude the fistulas. Long-term follow-up is essential to ensure absence of recurrence due to recanalization.

Surgical treatment of congenital pulmonary arteriovenous fistula in children

“…It is characterized by right-to-left shunting [2]. First described by Churton [3] in 1897, PAVF incidence is 2 to 3 per 100,000 inhabitants in the general population [4].…”

“…However, it may lead to complications, such as metal coil migration, fistula recanalization, incomplete embolization with residual fistula, lung infarction, or pneumothorax. Recanalization occurs in 5% to 10% of the cases as a result of the child's growth or of dilated accessory vessels [2,8,11].…”

“…Chest radiography usually reveals abnormal but unspecific lung density in the PAVF region [2,9]. Contrast-enhanced transthoracic ultrasound may be used as a diagnostic method, in which the agitated saline containing microbubbles in injected peripherally and may be visualized in the left atrium bypassing the capillary barrier in the lung [8].…”

Hereditary haemorrhagic telangiectasia: a cause of preventable morbidity and mortality

“…The incidence of sporadic PAVMs is probably overestimated, because of underdiagnosis of HHT [5]. Conversely, approximately 15-35% of patients with HHT have PAVMs; the incidence of PAVMs in HHT varies depending on the specific genetic mutation present [1,[15][16][17]. PAVMs seldom manifest clinically until adult life, after the vessels have been subjected to pressure over several decades [5].…”

Transcatheter Device Occlusion of Multiple Large Pulmonary Arteriovenous Malformations in Two Symptomatic Pediatric Patients

“…ulmonary arteriovenous malformations (AVMs) have long been recognized as a noncardiac etiology of cyanosis and have been well described in both the adult and pediatric populations. [1][2][3][4][5][6] Clinical manifestations have been reported to include exercise intolerance; cyanosis and clubbing; congestive heart failure; central nervous system sequelae, such as stroke or transient ischemic attack; and cerebral abscess. 1,5,7,8 Therapeutic interventions consisting of transcatheter embolization of pulmonary AVMs with various coils or detachable balloons have largely been performed on adults to date, 2,4,9,10 although there has been a recent report of coil occlusion of pulmonary AVMs in children.…”