Reperfusion of Pulmonary Arteriovenous Malformations after Embolotherapy
Section snippets
Patient Population
From a database of 112 patients with PAVMs treated consecutively with embolotherapy at our tertiarycare institution between September 1996 and January 2004, 19 patients with 33 angiographically confirmed reperfused PAVMs were identified based on review of imaging studies and reports as well as clinical notes. The 11 male and eight female patients ranged in age from 21 to 62 years (mean, 41 y). Eighteen patients (95%) had hereditary hemorrhagic telangiectasia and five patients (26%) had diffuse
PAVM Morphology before Embolization and Embolic Material Characteristics
Total follow-up from the time of suspected PAVM reperfusion on CT to the end of the study ranged from 12 to 84 months (mean, 40.8 mo). Three patients (one with diffuse disease and two with nondiffuse disease) had transient neurologic deficits during the period of known PAVM reperfusion. The angioarchitectural features in 14 patients (with 18 reperfused PAVMs) before initial embolotherapy are presented in Table 1. The data are presented descriptively with no statistical analysis. The feeding
DISCUSSION
To our knowledge, risk factors for reperfusion of PAVMs have not previously been studied comprehensively, although several authors have suggested based on anecdotal evidence that coil number, size, and location relative to the aneurysm may be factors that predict reperfusion. This study attempts to examine an association between these coil characteristics and PAVM reperfusion by comparison of reperfused PAVMs with nonreperfused PAVMs. Our findings corroborate previous observations that the use
References (22)
- et al.
Pulmonary arteriovenous malformations: diagnosis and transcatheter embolotherapy
J Vasc Interv Radiol
(1996) - et al.
Diffuse pulmonary arteriovenous malformations: characteristics and prognosis
Chest
(2000) - et al.
Embolotherapy of large pulmonary arteriovenous malformations: long-term results
Ann Thorac Surg
(1997) - et al.
Embolotherapy of pulmonary arteriovenous malformations: long-term results in 112 patients
J Vasc Interv Radiol
(2004) - et al.
Embolotherapy of pulmonary arteriovenous malformations with detachable balloons: long-term durability and efficacy
J Vasc Interv Radiol
(1999) - et al.
Embolotherapy of pulmonary arteriovenous malformations: efficacy of platinum versus stainless steel coils
J Vasc Interv Radiol
(2004) - et al.
Society of Interventional Radiology Clinical Practice Guidelines
J Vasc Interv Radiol
(2003) - et al.
Pulmonary arteriovenous fistulas: Mayo Clinic experience, 1982-1997
Mayo Clin Proc
(1999) - et al.
Pulmonary arteriovenous malformations: therapeutic options
Ann Thorac Surg
(1993) - et al.
Pulmonary arteriovenous malformations: a state of the art review
Am J Respir Crit Care Med
(1998)
Hereditary haemorrhagic telangiectasia and pulmonary arteriovenous malformations: issues in clinical management and review of pathogenic mechanisms
Thorax
Cited by (113)
Prospective Study of Polytetrafluoroethylene-Covered Microplugs and Detachable Coils for Embolization of Pulmonary Arteriovenous Malformations: Technical Results, Procedure Times, and Costs
2024, Journal of Vascular and Interventional RadiologyTransarterial Embolization of Simple Pulmonary Arteriovenous Malformations: Long-Term Outcomes of 0.018-Inch Coils versus Vascular Plugs
2024, Journal of Vascular and Interventional RadiologyPreliminary Experience with a Low-Profile High-Density Braid Occluder for Transcatheter Embolization of Pulmonary Arteriovenous Malformations
2024, Journal of Vascular and Interventional RadiologyThe role of interventional radiology in treatment of patients with hereditary hemorrhagic telangiectasia
2023, European Journal of RadiologyDiagnosis and Management of Persistent Pulmonary Arterio-venous Malformations following Embolotherapy
2023, Academic RadiologyCitation Excerpt :Results from previous studies recommend the use of two or more coils, which are at maximum 2 mm larger than the feeding artery, for adequate embolization (11,33). It has been emphasized by many studies that the initial distal coiling (<1cm from the sac) prevents reperfusion due to new accessory pulmonary artery feeders (11,44-46). It also keeps the option of repeat embolization open in case of reperfusion.
M.E.F. has received grant support from the Nelson Arthur Hyland Foundation and St. Michael's Hospital Research Institute. None of the authors have identified a conflict of interest.
From the 2004 SIR Annual Meeting.