Abstract No. 64 Analysis of complications and unsuccessful embolization of pulmonary arteriovenous malformations

Abstract

Embolotherapy is the standard treatment for pulmonary arteriovenous malformation (pAVM). The purpose of this study is to explore the reasons for unsuccessful embolization and complications associated with embolotherapy. This retrospective chart review study was approved by the IRB. Data were collected for all the embolization procedures that were performed at our institution for pulmonary AVM treatment between January 2003 and January 2020. All ages of both genders were included in the analysis. The reason for unsuccessful embolization and complications were recorded. One hundred and eighty-seven patients had a total of 341 embolization procedures at our institutions for the treatment of PAVM. There were 240 (70%) women and 101 (30%) men included with a mean age of 49 ± 18 and 38 ± 20 years, respectively. The average fluoroscopic time was 34 minutes (range 3.4 to 120 minutes). Of 341, 47(14%) procedures were unsuccessful. The reason for unsuccessful embolization were (in order of frequency): no PAVM detected on catheter angiogram (n = 17, 36%), pAVM too small to treat (n = 12, 25%), tortuous feeding artery causing technical difficulty assessing the artery (n = 7, 15%), No evidence of reperfusion on follow up pulmonary angiogram (that were done to detect reperfusion) (n = 6, 13%), systemic arterial supply to the pAVM causing vein to vein shunting (n = 3, 6%), patient’s condition (increased respiratory motion and intraprocedural bradycardia) aborting the procedure (n = 2, 4%). There were a total of 9 (2%) intraprocedural complications with 2 major complications aborting the embolotherapy. Embolization of pulmonary arteriovenous malformation is a very successful procedure with minor complications. The main reasons of unsuccessful embolotherapy are no evidence of pAVM during catheter angiogram, very small feeding artery size, and tortuous feeding artery.