Abstract
The purpose of this study is to describe our initial experience with embolization of pulmonary arteriovenous malformations (PAVMs) using hydrogel microcoils. The technical and radiological outcomes were retrospectively reviewed in seven patients with nine simple-type PAVMs (median feeder size 4 mm, range 3-6 mm) who underwent embolization. Hydrogel microcoils were mainly used, and detachable bare microcoils were combined as needed to occlude the terminal feeding artery just before the sac. Of a total of 43 microcoils, 30 (69.8%) hydrogel microcoils were deployed in eight PAVMs with the median number 3.5 (range 2 to 6) per lesion. All hydrogel microcoils were successfully deployed without microcatheter stuck or malposition. In the remaining one small PAVM, only soft bare microcoils were used, however, resulting in recanalization requiring additional coils in the second session. The venous sac was substantially shrunk in all lesions treated with hydrogel microcoils with the median size reduction rate 95.0% (range 81.8% to 99.0%) during the median follow-up period 10 months (range 6 to 18 months). In conclusion, hydrogel microcoils were safely and effectively applied for occluding PAVMs with relatively small feeders.
Highlights
Pulmonary arteriovenous malformations (PAVMs) are abnormal fistulous connections between pulmonary arteries and veins forming a venous sac
For asymptomatic PAVMs, the feeding artery 3 mm or greater in diameter is generally considered as the size threshold for embolization, embolization can be performed in smaller feeding arteries
We describe our initial experience with use of hydrogel microcoils in a series of patients with PAVMs with relatively small feeding arteries
Summary
Pulmonary arteriovenous malformations (PAVMs) are abnormal fistulous connections between pulmonary arteries and veins forming a venous sac. PAVMs occur either sporadically or as a part of manifestations of hereditary hemorrhagic telangiectasia (HHT). The patients may suffer from stroke or brain abscess due to paradoxical embolism, dyspnea and fatigue due to hypoxemia, and rarely, hemoptysis or hemothorax due to spontaneous rupture of the venous sac. According to the international guidelines for the diagnosis and management of HHT, transcatheter embolization is the first-line treatment for symptomatic PAVMs (Faughnan et al 2011). For asymptomatic PAVMs, the feeding artery 3 mm or greater in diameter is generally considered as the size threshold for embolization, embolization can be performed in smaller feeding arteries.
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