Outpatient Single-session Pulmonary Arteriovenous Malformation Embolization

Abstract

Pulmonary arteriovenous malformation (PAVM) embolization has traditionally been performed as an inpatient procedure, often with sequential procedures to treat multiple lesions. This approach is costly, inconveniences the patient, and may lead to noncompliance with embolotherapy. In the authors' hereditary hemorrhagic telangiectasia (HHT) center, all PAVM embolizations in teenagers and adults are performed in the outpatient setting and all accessible PAVMs are treated in a single session if possible. The present report describes results from this center on an intent-to-treat basis. Fifty-one patients whose ages ranged from 15 to 78 years (mean, 44 y), 47 with a confirmed diagnosis of HHT, underwent outpatient embolization in 63 procedures. Multiple procedures were performed when PAVMs were too numerous for single-session treatment (n = 7) or for PAVM recurrence/growth (n = 5). Planned multiple sessions were performed on consecutive days or at longer intervals at patient request. Patients were discharged after a 2-hour observation period. Outpatient single-session embolization was achieved in 44 of 51 patients (86%). When four or fewer PAVMs were present, single-session therapy was successful in 100% of cases. One patient with 10 PAVMs was admitted overnight at her request to complete the embolization the next day. All others were successfully treated as outpatients. No patient required admission during the postoperative period. A mean of 2.4 PAVMs were embolized per procedure (range, 1-9). Outpatient PAVM embolization is well tolerated, with single-session embolization of all PAVMs achievable in more than 85% of patients.