Transcatheter closure of pulmonary arteriovenous malformations with Amplatzer devices

Abstract

To review the authors' experience with transcatheter closure of pulmonary arteriovenous malformations (PAVMs) using amplatzer duct occluder (ADO) devices and vascular plugs (AGA Medical, Golden Valley, MN) and present a novel technique for delivery sheath placement and device delivery. PAVMs can cause cyanosis, fatigue, polycythemia, and thromboembolic phenomena. Transcatheter closure using coils, detachable balloons, and various devices has replaced surgery as the preferred therapy. Between January 2001 and December 2004, five patients (2M, 3F) of median age 33 years (14-49) were referred for transcatheter closure of multiple PAVMs. All patients were diagnosed previously with hereditary hemorrhagic telangectasia. The procedures were performed with sedation using a percutaneous transcatheter technique via the femoral vein under fluoroscopic guidance. A total of 14 PAVMs (11 ADO and 3 plugs) were closed in five patients. Three patients required two procedures after developing additional PAVMs. All attempts at PAVM closure were successful. Oxygen saturation increased from 88.4 +/- 6.1 to 96.4 +/- 0.5 (P < 0.05). No complications, including air or thromboembolism, hemoptysis, or chest pain, occurred. At median follow-up of 3.4 years (1.4-3.6), all patients are alive and have suffered no embolic phenomena or infection. Amplatzer patent ductus arteriosus occluders and vascular plugs are safe and effective in the closure of PAVMs in the acute setting and at intermediate follow-up. Placement of a long delivery sheath can be facilitated by the methods outlined. Though promising, further clinical evaluation of these devices is required. Their apparent advantages must be compared to other techniques and devices for transcatheter PAVM closure.