Venous sac embolization of pulmonary arteriovenous malformation: safety and effectiveness at mid-term follow-up

Kono, Kenji; Urashima, Masaki; Yamagami, Takuji; Kakizawa, Hideaki; Matsuura, Noriaki; Matsuura, Akiko; Ohnari, Tae; Ishikawa, M.; Awai, Kazuo

doi:10.1177/0284185113512123

Cited by 19 publications

(16 citation statements)

References 17 publications

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“…In this study, we placed some coils inside the venous sac to make a scaffold so as to embolize the feeding artery tightly. It has been reported that embolization of both the feeding artery and venous sac may be useful [ 22 – 24 ], and some authors recommended tightly packing the venous sac [ 23 ]. However, doing it needs many coils and has a high cost.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Hydrogel-Coated Coils in Embolization of Pulmonary Arteriovenous Malformations

Shimohira

Kawai

Hashizume

et al. 2018

Cardiovasc Intervent Radiol

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PurposeTo evaluate the usefulness of hydrogel-coated coils for preventing recanalization after coil embolization of pulmonary arteriovenous malformations (PAVMs).Materials and MethodsThirty-seven consecutive patients with 57 untreated PAVMs underwent coil embolization with hydrogel-coated coils between January 2013 and Jun 2017. The mean age was 49 years (range 9–83 years), and there were seven male patients and 30 female patients. The median size of the feeding artery was 3.7 mm (range 1.5–6.1 mm), and the median size of the venous sac was 9.3 mm (range 2.6–36.6 mm). For all PAVM, embolization was attempted using 0.018-in. hydrogel-coated coils with or without other coils (0.0135–0.018-in. bare platinum coils and fibered platinum coils). Technical success rate, recanalization rate, and complications were evaluated. Technical success was defined as completion of embolization using hydrogel-coated coils. Recanalization was evaluated with time-resolved magnetic resonance angiography and/or pulmonary angiography.ResultsIn 56 of 57 PAVMs, embolization was successfully performed with hydrogel-coated coils. Therefore, the technical success rate was 98% (56/57). The number of PAVMs at risk was 56, 42, 18, and 12 at 0, 12, 24, and 36 months, respectively. There was no recanalization with a mean follow-up period of 19 months (range 2–47 months) in 56 PAVMs embolized with hydrogel-coated coils. There were no major complications. As a minor complication, local pain was observed in 8 of 43 sessions (19%) after embolization.ConclusionsHydrogel-coated coils may be useful for preventing recanalization after the embolization of PAVMs.

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Section: Discussionmentioning

confidence: 99%

Usefulness of Hydrogel-Coated Coils in Embolization of Pulmonary Arteriovenous Malformations

Shimohira

Kawai

Hashizume

et al. 2018

Cardiovasc Intervent Radiol

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“…6 ). Some authors have noted the importance of embolization of feeding artery close to the sac, while others demonstrated the efficacy of venous sac embolization to prevent persistence [ 9 , 11 , 15 – 17 ]. However, they did not mention where the fistulous point in PAVM is.…”

Section: Discussionmentioning

confidence: 99%

Where is the Origin of the Last Normal Branch from Feeding Artery of Pulmonary Arteriovenous Malformations?

Maruno

Kiyosue

Hongo

et al. 2018

Cardiovasc Intervent Radiol

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PurposeReperfusion via pulmonary-to-pulmonary arterial anastomoses is known as one type of recurrence of pulmonary arteriovenous malformations (PAVMs) after embolization. It is important to occlude the fistulous portion beyond the origin of the last normal branch from feeding artery of PAVMs to prevent recurrence. In this study, we evaluate the origin of the last normal branch by CT as well as its visibility on pulmonary arteriography (PAG).Materials and MethodsWe reviewed forty patients with 77 PAVMs who underwent coil embolization between October 2007 and December 2017. All patients underwent MDCT before embolization. Axial and MPR CT lung images were reviewed with special interests in the origin of the last normal branch from feeding artery of PAVMs. The origin was classified into three portions, including sac, junction (portion just proximal to the sac) and proximal feeder (more than 5 mm proximal to the sac). We also evaluated whether PAG can depict the normal branches detected by MDCT.ResultsMDCT showed that the last normal branch originated from sac in 30 PAVMs (39.0%), junction in 39 (50.6%), and proximal feeder in 8 (10.4%).On selective PAG, the last normal branch could be visualized in 30 PAVMs (39.0%), although it could not be visualized due to high-flow shunt in the other 47 PAVMs.ConclusionsSelective PAG frequently fails to demonstrate the last normal branch from feeding artery of PAVMs, which often originates from the sac. Pretherapeutic evaluation of CT images of the last normal branch is important to prevent reperfusion of PAVMs.Level of EvidenceLevel 3, local non-random sample.

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“…Recognizing high reperfusion rates and how to decrease them is of clinical importance. Embolization of the feeding artery and the venous sac was previously shown to prevent reperfusion (1,19), and our primary embolization was performed according to this method in the present study. However, the reperfusion rates of primary embolization were higher; the 3-month, 6-month, 12-month, and 24-month reperfusion rates for the 12 primary embolization procedures were 8%, 27%, 36%, and 49%, respectively.…”

Section: Discussionmentioning

confidence: 93%

Reperfusion Rates of Pulmonary Arteriovenous Malformations after Coil Embolization: Evaluation with Time-Resolved MR Angiography or Pulmonary Angiography

Shimohira

Kawai

Hashizume

et al. 2015

Journal of Vascular and Interventional Radiology

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Venous sac embolization of pulmonary arteriovenous malformation: safety and effectiveness at mid-term follow-up

Abstract: Venous sac embolization for PAVMs might be safe and more effective with no reperfusion than the standard pulmonary arterial embolization.

Cited by 19 publications

References 17 publications

Usefulness of Hydrogel-Coated Coils in Embolization of Pulmonary Arteriovenous Malformations

Usefulness of Hydrogel-Coated Coils in Embolization of Pulmonary Arteriovenous Malformations

Where is the Origin of the Last Normal Branch from Feeding Artery of Pulmonary Arteriovenous Malformations?

Reperfusion Rates of Pulmonary Arteriovenous Malformations after Coil Embolization: Evaluation with Time-Resolved MR Angiography or Pulmonary Angiography

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