Abstract
PurposeReperfusion via pulmonary-to-pulmonary arterial anastomoses is known as one type of recurrence of pulmonary arteriovenous malformations (PAVMs) after embolization. It is important to occlude the fistulous portion beyond the origin of the last normal branch from feeding artery of PAVMs to prevent recurrence. In this study, we evaluate the origin of the last normal branch by CT as well as its visibility on pulmonary arteriography (PAG).Materials and MethodsWe reviewed forty patients with 77 PAVMs who underwent coil embolization between October 2007 and December 2017. All patients underwent MDCT before embolization. Axial and MPR CT lung images were reviewed with special interests in the origin of the last normal branch from feeding artery of PAVMs. The origin was classified into three portions, including sac, junction (portion just proximal to the sac) and proximal feeder (more than 5 mm proximal to the sac). We also evaluated whether PAG can depict the normal branches detected by MDCT.ResultsMDCT showed that the last normal branch originated from sac in 30 PAVMs (39.0%), junction in 39 (50.6%), and proximal feeder in 8 (10.4%).On selective PAG, the last normal branch could be visualized in 30 PAVMs (39.0%), although it could not be visualized due to high-flow shunt in the other 47 PAVMs.ConclusionsSelective PAG frequently fails to demonstrate the last normal branch from feeding artery of PAVMs, which often originates from the sac. Pretherapeutic evaluation of CT images of the last normal branch is important to prevent reperfusion of PAVMs.Level of EvidenceLevel 3, local non-random sample.
Highlights
Pulmonary arteriovenous malformations (PAVMs) are rare vascular shunts communicating between pulmonary arteries and veins without an intervening capillary network
multidetector CT (MDCT) showed that the last normal branch originated from sac in 30 pulmonary arteriovenous malformations (PAVMs) (39.0%), junction in 39 (50.6%), and proximal feeder in 8 (10.4%).On selective pulmonary arteriography (PAG), the last normal branch could be visualized in 30 PAVMs (39.0%), it could not be visualized due to high-flow shunt in the other 47 PAVMs
Selective PAG frequently fails to demonstrate the last normal branch from feeding artery of PAVMs, which often originates from the sac
Summary
Pulmonary arteriovenous malformations (PAVMs) are rare vascular shunts communicating between pulmonary arteries and veins without an intervening capillary network. Recurrent PAVMs may cause serious complications, such as brain abscesses and paradoxical embolisms [5, 9]. Reperfusion via the anastomoses between the pulmonary arterial branches or systemic arteries and pulmonary arterial branches is known as one type of recurrence pattern after the transcatheter embolization of PAVMs [5, 9,10,11]. To prevent ‘‘reperfusion’’ via the anastomoses between pulmonary arterial branches, it is important to occlude the fistulous portion beyond the origin of the last normal branch from the feeding artery. We retrospectively evaluated the origin of the last normal branch from the feeding artery of PAVMs by CT as well as its visibility on pulmonary angiography (PAG)
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