Embolization of pulmonary AVMs: no consistent effect on pulmonary artery pressure

¹ NHLI Cardiovascular Sciences, Imperial College London; and Respiratory Medicine
² Respiratory Medicine
³ NHLI Cardiovascular Sciences, Imperial College London
⁴ Dept of Imaging, Hammersmith Hospital, London W12 ONN, UK

^* To whom correspondence should be addressed. E-mail: c.shovlin{at}imperial.ac.uk.

	Abstract

Increasing evidence supports the use of embolization to treat pulmonary arteriovenous malformations (AVMs). Most pulmonary AVM patients have hereditary haemorrhagic telangiectasia (HHT), a condition that may be associated with pulmonary hypertension. We tested whether PAVM embolization increases pulmonary artery pressure (PAP) in patients without baseline severe pulmonary hypertension.

PAP were measured at the time of PAVM embolization in 143 individuals, 131 (92%) of whom had underlying HHT. Angiography/embolization was not performed in four individuals with severe pulmonary hypertension, whose systemic arterial oxygen saturation exceeded levels usually associated with dyspnoea in PAVM patients.

In 143 patients undergoing PAVM embolization, PAP was significantly correlated with age, with the most significant increase occurring in the upper quartile (age >58yr). In 43 patients with repeated measurements, there was no significant increase in PAP as a result of embolization. In half, embolization led to a fall in PAP. The maximum rise in PAP mean was 8mmHg: Test balloon occlusion was performed in one of these individuals, and did not predict the subsequent rise in PAP following definitive embolization of the pulmonary AVMs.

In this series which excluded patients with severe pulmonary hypertension, PAP was not increased significantly by PAVM embolization.