Embolization Of Feeding Arteries Research Articles

Minimizing blood loss with direct percutaneous polymethylmethacrylate embolization before corpectomy for vascular spinal tumors.

Standard surgical treatment for vascular spinal tumors, including renal cell carcinomas and hemangiomas, may result in significant blood loss despite preoperative arterial tumor embolization. This is a retrospective review of 12 patients who underwent direct percutaneous polymethylmethacrylate embolization (DPPE) with or without feeding artery embolization before partial or complete corpectomy for the resection of vascular spinal tumors (2013-2018). Estimated blood loss (EBL) was compared to the blood loss reported in the literature and to patients receiving standard arterial embolization before surgery. The mean EBL for 12 patients was 1030 mL; three of 12 patients required blood transfusions. For the single level corpectomies, the EBL ranged from 100 mL to 3900 mL (mean 640 mL). This mean blood loss was not increased in patients receiving only DPPE preoperatively versus those patients receiving preoperative arterial embolization in addition to DPPE (1005 vs. 1416 mL); in fact, the EBL was significantly reduced for those undergoing DPPE alone. In this initial study, nine patients treated with DPPE embolization alone before spinal tumor resection demonstrated reduction of intraoperative blood loss compared to three patients having arterial embolization with DDPE.

Utilizing the supreme anterior connecting artery in embolization of a parietal lobe arteriovenous malformation.

The supreme anterior connecting artery (SAConnA) is an exceedingly rare anatomical variant. This artery may interconnect bilateral anterior cerebral arteries (ACAs), yet its existence and clinical implications are scarcely discussed in the literature. A 60-year-old man with no significant past medical or family history presented to our emergency department. He exhibited right homonymous hemianopsia and Gerstmann's syndrome. Cranial computed tomography indicated a left parietal lobar hemorrhage, and digital subtraction angiography revealed a flow-related aneurysm in the anterior communicating artery, with the arteriovenous malformation (AVM) receiving blood supply from the anterior, middle, and posterior cerebral arteries. Notably, the angiography also disclosed the presence of a SAConnA. We adopted a treatment approach of staged embolizations followed by resection. During the second session, the SAConnA was utilized for the embolization of feeding arteries within the ACA system. This case demonstrates that SAConnA can be associated with AVMs and can serve as an access route during AVM embolization. SAConnA may be a remnant artery interconnecting bilateral ACAs formed during early embryogenesis.

Combined left thoracoscopic and median sternotomy approach to resect aortopulmonary mediastinal paraganglioma following feeding artery embolization: a case report

BackgroundAortopulmonary mediastinal paragangliomas are rare. Complete resection of the tumor is desirable regardless of tumor size in view of the risk of sudden death induced by adjacent organ compression and poor prognosis after partial resection or untreated observation. Due to the hypervascularity of the tumor, the risk of intraoperative bleeding is significant, and cardiopulmonary bypass is often required for complete resection.Case presentationThe patient was diagnosed as having bilateral carotid body tumors and supposedly an aortic body tumor at the age of 43 and eventually underwent resections of bilateral carotid body tumors at the age of 52. The pathology of the carotid body tumors was compatible with paraganglioma on both sides. A familial succinate dehydrogenase subunit D mutation was subsequently identified. Five years later, a contrast-enhanced computed tomography scan showed an enlarged tumor of 45 mm in size in the aortopulmonary mediastinum. Based on the previously known genetic mutation, the tumor was thought to be a paraganglioma. After confirming with an endocrinologist that the aortic body tumor was non-functional, radiologists performed preoperative embolization of the feeding vessels. Subsequently, a surgical team consisting of thoracic and cardiovascular surgeons resected the aortic body tumor using a video-assisted small left thoracotomy approach combined with a median sternotomy approach. The procedure was completed without cardiopulmonary bypass or blood transfusion. The patient was discharged home on postoperative day 9 uneventfully.ConclusionsAfter conduction of preceding interventional embolization of multiple feeding vessels, we employed a video-assisted thoracoscopic surgical approach to dissect the aspects of the tumor adjacent to the esophagus, descending thoracic aorta, and left pulmonary artery, followed by a median sternotomy approach to dissect the other aspects of the tumor adjacent to the ascending aorta, aortic arch, right pulmonary artery, and trachea. There have been no reports on scheduled preoperative embolization of feeding vessels to an aortopulmonary mediastinal paraganglioma. Multidisciplinary approach was effective for complete resection of this challenging rare mediastinal tumor.

Transcatheter Arterial Embolization Using Imipenem/Cilastatin Sodium for Chronic Low Back Pain Resistant to Conservative Treatment: A Pilot Study with 2-Year Follow-Up.

To evaluate the safety and 2-year follow-up clinical outcomes of transcatheter arterial embolization (TAE) using imipenem/cilastatin sodium for chronic low back pain resistant to conservative treatment. A retrospective review identified 14 patients who underwent TAE for chronic low back pain between October 2017 and August 2018. Patients with low back pain related to the facet or sacroiliac joint, lasting ≥ 6months, refractory to ≥ 3months of conservative treatment were eligible for TAE. Each patient received embolization of feeding arteries of painful regions. The changes in brief pain inventory (BPI) scores, adverse events, and the Oswestry Disability Index (ODI) were evaluated at baseline and 1, 3, and 24months after TAE. Clinical success was defined as BPI maximum pain intensity decrease of ≥ 2 and ODI decrease of ≥ 10 points from baseline. Follow-up data were available in 13 and 11 patients, at 3 and 24months after embolization, respectively. Intention-to-treat clinical success was obtained in 11/14 (79%) of patients at 3months and 8/14 (57%) of patients at 24months after TAE. Mean BPI maximum pain intensity and ODI scores decreased significantly from baseline to 1, 3, and 24months after treatment (7.6 vs.. 4.3, 3.4, and 4.1; 40.8 vs 21.5, 20.0, and 23.8, respectively; all P < 0.01). No major adverse events were associated with the procedures. TAE is one possible treatment option for patients with chronic low back pain refractory to conservative treatment.

Pulmonary Arteriovenous Malformation Embolization: So Much Left to Learn

Embolization of pulmonary arteriovenous malformations (PAVMs) has been utilized effectively for more than 40 years. Initially performed using conventional coils and/or detachable balloons in the era of cut-film angiography, currently, there is an armamentarium of embolic devices and methods for effecting therapy. Two studies in this issue of the Journal of Vascular Interventional Radiology compare traditional feeding artery embolization with venous sac (“nidal”) embolization, and in both, sac embolization appeared to improve the occlusion rate of lesions (1,2).

Venous Sac and Feeding Artery Embolization versus Feeding Artery Embolization Alone for Treating Pulmonary Arteriovenous Malformations: Draining Vein Size Outcomes

PurposeTo investigate and compare venous sac and feeding artery embolization (VFE) with feeding artery embolization (FAE) alone for treatment of pulmonary arteriovenous malformations (PAVMs), based on difference in outcomes in decrease of the size of the draining vein. Materials and MethodsTwenty-six patients (7 male and 19 female; median age [interquartile range], 58 years [46–65 years]) with 42 simple PAVMs treated with coil embolization between August 2005 and December 2018 were retrospectively evaluated. Twenty PAVMs were treated with FAE early in the study period and compared with 22 PAVMs treated with VFE later in the study period. Follow-up computed tomography images obtained 8–20 months after embolotherapy were used for outcome analysis. Data related to patient demographics; follow-up period; baseline diameters of the feeding artery, venous sac, and draining vein; draining vein diameter after treatment; and decrease in the size of the draining vein, including the number reaching a threshold of 70% decrease, were compared between the 2 groups. ResultsThe draining vein decreased in size by a median of 46.4% in the FAE group and 66.3% in the VFE group, and the difference between the 2 groups was statistically significant (P = .009). There were no significant differences in the other parameters. ConclusionsVFE leads to a greater decrease in the size of the draining vein than FAE, suggesting that VFE results in more complete occlusion than FAE for treatment of PAVMs.

Comparison of Feeding-Artery-Only versus Nidus-Plus-Feeding-Artery Embolization of Pulmonary Arteriovenous Malformations

PurposeTo compare coil embolotherapy outcomes of feeding-artery-only versus nidus-plus-feeding-artery technique for treating pulmonary arteriovenous malformations (PAVMs). Materials and MethodsA total of 219 treatment-naïve PAVMs embolized in 90 patients at a single center from 2008 to 2018 met inclusion criteria for retrospective evaluation. Of the patients, 87% had a diagnosis of hereditary hemorrhagic telangiectasia (HHT). Feeding artery (FA) diameters ≥2 mm were treated. Coil embolization techniques were classified on the basis of embolic deployment zone: (i) distal feeding artery (DFA) technique (coil-to-nidus distance ≤ 1 cm) or (ii) nidus plus feeding artery (NiFA) technique. Successful embolization predictors were assessed using a multivariate linear regression model with input from patient- and PAVM-specific variables. ResultsTreatment success was achieved in 192 of 219 PAVMs (87.7%) over a mean follow-up period of 19 months. Statistically significant predictors of success in the linear regression model included simple angioarchitecture, NiFA embolization technique, and shorter follow-up duration. Stratified by technique, success rates were 99 of 105 (94.3%) and 93 of 114 (81.6%) PAVMs for NiFA and DFA, respectively (P = .007). On average, NiFA-embolized PAVMs had a larger FA diameter (3.6 mm vs 2.7 mm, P < .001) and comprised more complex PAVMs (48% vs 22%, P < .001) than DFA. Treatment success was not significantly associated with sac size or FA diameter. ConclusionsCoil embolization of both the nidus and FA was associated with a higher persistent occlusion rate than FA embolization alone.

Four-dimensional multifusion imaging for assessment of meningioma hemodynamics

We introduce our new image analysis method, 4-dimensional (4D)-multifusion imaging (four-phase 4D-multifusion image and dynamic 4D-multifusion image), and its clinical value in four illustrative cases of surgically treated meningiomas. In 4D-multifusion imaging, hemodynamic information from 4D-CTA was incorporated into advanced 3D images. Bone subtracted 4D-CTA volume data were divided into four phases: early arterial, late arterial, early venous, and late venous. Four-phase 4D-multifusion image was created by combining integrated vascular phase images with advanced 3D image. By subdividing the integrated vascular phase image into 10 dynamic images with gradation colors, a series of dynamic 4D-multifusion images from the initial early arterial to the last late venous phase image were displayed sequentially to simulate blood flow through the cerebral vessels. With this method, it was possible to identify the arterial feeders and their entry points into a meningioma, the pattern and distribution of tumor stain, and the drainage routes. Complicated anatomical and hemodynamic information was obtained simultaneously on freely rotated images, and pre-surgical simulation with 4D-multifusion imaging was useful for intracranial meningiomas in planning the surgical strategy and procedures including indication of a presurgical feeding artery embolization, selecting an appropriated approach route. In addition, 4D-multifusion imaging could be applicable to other hypervascular tumors and vascular lesions with arteriovenous shunts or collaterals.

Saving of the blood loss during carotid body tumor surgery-efficacy of the preoperative embolization of feeding arteries just before surgery

Saving of the blood loss during carotid body tumor surgery-efficacy of the preoperative embolization of feeding arteries just before surgery

Endovascular Embolization of a Previously Treated Renal Arteriovenous Malformation Presenting With Gross Hematuria

Renal arteriovenous shunts are direct communications between the supplying artery and draining vein without the presence of an intervening capillary bed. They can be traumatic or nontraumatic. Coils can be used for embolization of feeding arteries; however, they do not treat the nidus directly. We report a case in which proximal coil placement in feeding arteries led to recanalization of the renal AV shunt through collaterals, resulting in recurrent hematuria. The case was subsequently managed by embolizing the nidus by N-butyl 2-cyanoacrylate glue.

PART OR NOT TO PART: BRONCHO-PULMONARY SEQUESTRATION, A RARE BUT POTENTIALLY DANGEROUS ANATOMICAL ANOMALY

TYPE: Abstract Publication TOPIC: Genetic and Developmental Disorders PURPOSE: Bronchopulmonary sequestration is a rare but potentially dangerous anatomical anomaly. With our case, we hope to increase awareness about this entity. METHODS: 26 year-old female presented with right-sided pleuritic chest pain and associated intermittent dry cough. She denied dyspnea, wheezing, hemoptysis, fever, chills or sick contacts. Medical history was significant for SLE on hydroxychloroquine. Physical exam and initial lab work were unremarkable. CT chest with IV contrast incidentally revealed a focal area of consolidation in the RLL with large feeding vessel arising directly from descending thoracic aorta. No discrete draining veins were identified. She was diagnosed with intralobar RLL bronchopulmonary sequestration. Her chest pain was attributed to serositis and improved with short course of steroids and NSAIDs. But management of her bronchopulmonary sequestration was tricky. RESULTS: It is a rare abnormality of the respiratory tract consisting of nonfunctioning lung tissue lacking communication with tracheobronchial tree and receiving its arterial blood supply from systemic circulation. Usually diagnosed in-utero or in childhood, but can rarely be asymptomatic, eventually leading to major complications like massive hemoptysis, recurrent pneumonias, high-output cardiac failure; occasionally reports of neoplasms arising within the sequestration have been reported. CONCLUSIONS: Management options include observation, surgical resection or coil embolization of feeding artery. We discussed her case in multidisciplinary pulmonary-radiology conference. She did not have high risk features like large lesion ∼20% of hemithorax, bilaterality, multifocal/cystic lesions, but due to risk of infection and hemoptysis, consensus opinion recommended treatment with surgical resection of the RLL sequestration. CLINICAL IMPLICATIONS: Bronchopulmonary sequestration requires careful risk benefit deliberation. DISCLOSURE: No significant relationships. KEYWORD: Bronchopulmonary sequestration

Laparoscopic removal of a kidney tumor after superselective embolization of the kidney vessels

The study objective is to evaluate the effectiveness of using superselective embolization of the renal arterial bed prior to organ-preserving laparoscopic kidney tumor resection.Materials and methods. At the Center for Urology, Kidney Transplantation and Nephrology of the National Research Oncology Center (Nur-Sultan, Kazakhstan) between 2015 and 2019 laparoscopic kidney tumor resection was performed in 45 patients; in 9 patients with stage T1 kidney tumors, superselective embolization was also performed. Mean age of the patients was 54 years, mean tumor diameter was 2.8 cm. Localization near the kidney pole and presence of an artery isolatedly supplying the tumor were the main indications for superselective embolization of the feeding artery prior to kidney resection.Results. Mean blood loss was 280 ml. Complications characteristic of post-embolization period (pain, fever, arterial hypertension), as well as loss of function of the organ, were absent 3, 6 and 12 months after the procedure per laboratory and radiological examinations.Conclusion. Superselective embolization of the tumor feeding artery is an effective method allowing to minimize warm ischemia of the renal parenchyma and perform kidney resection with minimal blood loss.The authors declare no conflict of interest.All patients gave written informed consent to participate in the study and to the publication of their data.

Abstract No. 663 Greater shrinkage of the draining vein of pulmonary arteriovenous malformations after venous sac and feeding artery embolization than after feeding artery embolization alone

Abstract No. 663 Greater shrinkage of the draining vein of pulmonary arteriovenous malformations after venous sac and feeding artery embolization than after feeding artery embolization alone

Embolization using hydrogel-coated coils for pulmonary arteriovenous malformations

PurposeTo prospectively evaluate the efficacy and safety of embolization using hydrogel-coated coils for the treatment of pulmonary arteriovenous malformations (PAVMs). Materials and methodsThe outcomes of 21 PAVMs in 19 patients (3 men and 16 women; mean age, 58.8±15.2 [SD] years; age range 14–78 years) treated by venous sac embolization (VSE) with additional feeding artery embolization were prospectively evaluated. For VSE, using one or more 0.018-inch hydrogel-coated coils was mandatory. Recanalization and/or reperfusion were evaluated by pulmonary arteriography 1 year after embolization. ResultsThe mean feeding artery and venous sac sizes were 4.0mm and 8.5mm, respectively. Embolization was successfully completed in 20/21 PAVMs, yielding a technical success rate of 95%. The feeding artery was also embolized in 17/20 successful PAVMs (85%). A technical failure occurred in one PAVM, where embolization was abandoned because of migration of one bare coil to the left ventricle. The mean numbers of hydrogel-coated coils and bare platinum detachable coils used for VSE were 3.3±2.1 (SD) (range, 1–8) and 4.4±3.9 (SD) (range, 1–17), respectively. The mean percentages of hydrogel-coated coils in number, length, and estimated volume were 42.9%, 33.3%, and 72.7% respectively. One patient with one PAVM was lost to follow-up after 3 months. Neither recanalization nor reperfusion was noted in the remaining 19 PAVMs (success rate, 19/19 [100%]). One grade 4 (coil migration) adverse event occurred, and it was treated without any sequelae. ConclusionVSE using hydrogel-coated coils with additional feeding artery embolization is a safe and effective treatment for PAVM.

03:54 PM Abstract No. 244 Direct percutaneous puncture and embolization of visceral pseudoaneurysms: safety and clinical efficacy

To assess the safety and clinical efficacy of direct percutaneous puncture and embolization in treatment of visceral pseudoaneurysms. Retrospective analysis of all patients who underwent direct percutaneous puncture of pseudoaneurysm (PSA) and embolization between January 2012 to August 2018 was done. Study included 36 patients (27 male and 9 female) with mean age of 39 years (10-71 years). Indications for direct percutaneous embolization were : difficult catheterization of feeding artery, previous embolization of proximal artery, inability to identify feeding artery on angiography. Patients demography, details of endovascular procedure, complications and clinical outcomes were evaluated. Patients were followed up for recurrence of PSA and symptoms (mean follow : 1-24 months). 28 patients had pancreatitis related PSA, 3 patients had post traumatic PSA, 2 patients had postoperative PSA, 2 PSAs were incidentally detected. Splenic artery was the most commonly involved vessel (n=19). 15 patients had difficult catheterization, 12 patients had prior embolization of feeding artery, in 8 patients feeding artery was not identifiable on angiography and 1 patient had common hepatic artery dissection. NBCA (N-butyl cyanoacrylate) with lipiodol was used in 27 (75%) patients, coils were used in 1 (2.8%) patient and both coils and NBCA were used in 8 (22.2%) patients. Embolization of PSA was successful in all cases except in one case where feeder branch was embolized endovascularly using coils. No major procedure related complications were noted. Recurrent PSA noted in one case which was embolized with NBCA and coil. In another 2 cases, there was recurrence of PSA at sites other than previously embolized. Self limiting splenic infarct was seen in 6 patients. Mild abdominal pain was noted in patients embolized with NBCA. 1 patient developed liver infarct and subsequent liver abscess requiring percutaneous drainage. Direct percutaneous puncture and embolization is a safe and effective treatment of visceral PSAs and can be considered as an alternative treatment in patients with failed endovascular approach. This is the largest study group of direct percutaneous embolizations of visceral PSA.

Transarterial embolization of carvernous sinus dural arteriovenous fistulas of slender feeding artery with rapid injection of Onyx

Objective To observe the efficacy of transarterial embolization of carvernous sinus dural arteriovenous fistulas (CSDAVFs) with slender feeding artery by rapid injection of Onyx. Methods From December 2010 to December 2016, a total of 20 patients with CSDAVFs with slender feeding artery were admitted to the Neurosurgery Department of the First Affiliated Hospital of Soochow University (12 cases), Changhai Hospital of the Second Military Medical University (4 cases) and the Second Affiliated Hospital of Medical College, Zhejiang University (4 cases). Those clinical data were analyzed retrospectively in this study. All underwent transarterial embolization with rapid injection of Onyx. Results Twenty-two interventional therapeutic procedures and embolization of feeding arteries were performed in all 20 patients, which involved ascending pharyngeal arteries in 11, middle meningeal arteries in 7, accessory meningeal arteries in 2 and internal maxillary arteries in 2. The mean time of Onyx injection was 5 sec-4 min and the volume of Onyx injected was 0.4-1.5 ml. Postoperative immediate complete embolization was achieved in 8, near-complete embolization in 11 and partial embolization in 1 (with 3 repeats of procedures). Postoperatively, there were 2 cases of ipsilateral facial numbness and 1 case of ipsilateral eyelid ptosis and eye movement disorder occurring after 3 times of arterial embolization. The follow-up period was 2-32 months, with an average of 9.5±2.7 months. In 19 patients with complete embolization and secondary embolization, the clinical symptoms disappeared completely. Among them, 18 cases of conjunctival hyperemia and ocular protrusion disappeared within 2 weeks after operation, and 1 case of heavier conjunctival edema disappeared within 3 weeks after operation. The symptoms of diplopia and vision loss improved within 1 to 3 months after surgery, and there was no recurrence. Twelve patients were followed up by DSA, and 7 patients with complete embolization showed complete occlusion of the fistula and no recurrence. Conclusion Transarterial embolization with rapid injection of Onyx may effectively treat CSDAVFs with slender feeding artery with relatively little complications and satisfactory follow-up results. Key words: Arteriovenous fistula; Dura mater; Carvernous sinus; Treatment outcome

Embolization of feeding arteries and symptom alleviation of mixed dural-pial arteriovenous malformations

BackgroundTo examine whether embolization of dural or pial blood supply branch is more efficient for symptom alleviation for unruptured mixed dural-pial arteriovenous malformations (DPAVMs).MethodsWe retrospectively reviewed 30 DPAVM patients from a database of 425 consecutive cerebral arteriovenous malformation (CAVM) patients who underwent endovascular embolization between January 2010 and December 2015 at our institution. Demographics, angioarchitectural characteristics, endovascular embolization details and patients clinical outcomes were recorded. The modified Rankin Scale (mRS), Engel‘s classification and Visual Analogue pain scale (VAS) were used to assess clinical outcomes.ResultsThe single center cohort data shows that the incidence of DPAVM is 7.1%. Among the 30 DPAVM patients, 9 (30.0%) are ruptured and 21 (70.0%) are unruptured. Four (19.0%) of the 21 unruptured DPAVM patients are failed to follow-up, leaving 17 to analysis the clinical outcomes. Clinical presentations of the 17 unruptured DPAVM patients are epilepsy (n = 10), headache (n = 5) and focal neurological dysfunction (n = 2). Six patients have DPAVMs occluded via pial blood supply branches, 4 via dural branches and 7 via both pial and dural branches. Unruptured DPAVM patients with nidus occluded via dural blood supply branches, or both pial and dural branches have higher symptom alleviation rate than patients with nidus occluded via pial branches (100%/85.7% vs 66.7%).ConclusionsFor DPAVM patients presented with epilepsy, headache and FND, embolization via dural blood supply branches may be more efficient for symptom alleviation. Large cohort study is needed to confirm the generalizability.

Solitary fibrous tumor in the abdomen and pelvis: A case series with radiological findings and treatment recommendations

This study presents the radiological findings of seven cases of solitary fibrous tumor (SFT) in the abdomen and pelvis. A retrospective search of the pathology database at our institution was performed to identify cases of SFT in the abdomen and pelvis. After identifying seven cases, cross-sectional imaging was reviewed and characterized.We conclude that SFTs in the abdomen and pelvis should be considered with well-defined, circular, hypervascular masses. Pelvic SFTs should be considered with homogenous, avidly enhancing masses. Embolization of feeding arteries can allow safe surgical resection or biopsy, but embolization appears to not offer a definitive therapy.

術前動脈塞栓術と自己血輸血にて切除しえたChronic Expanding Hematomaの1例

術前動脈塞栓術と自己血輸血にて切除しえたChronic Expanding Hematomaの1例

Hemiparesis With Hemoptysis

SESSION TITLE: Student/Resident Case Report Poster - Signs and Symptoms of Chest Disease SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: A Pulmonary arterio-venous malformation(PAVM) is a direct communication between the branches of pulmonary artery and pulmonary veins and may be congenital or acquired. These lesions are anatomical right to left shunts and may cause strokes as well as high output heart failure and hypoxemia. Increased blood flow and increased venous distensibility secondary to progesterone effect in pregnancy may increase PAVM growth and its associated complications. Majority of subjects are diagnosed in the first three decades of life. CASE PRESENTATION: A 36-year-old female presented to us with complaints of “blood in her mouth”. She initially noted it two years ago during her only pregnancy. This subsided spontaneously. She subsequently had two further episodes four weeks apart prior to current presentation during menstruation. She also has history of two episodes of transient ischemic attacks with a negative neurological work up. Prior workup included a normal Gastrointestinal and Otolaryngologic evaluation. Her vitals and physical exam was entirely normal. Initial laboratory investigations revealed a normocytic anemia. Blood chemistry, coagulation parameters, and serologies were normal. A computed tomography angiography(CTA) of the chest revealed an opacity in the left lower lobe suggestive of arteriovenous malformation(AVM). A bronchoscopy was negative for endobronchial lesions or bleeding. The patient underwent embolization of the AVM feeding artery with an amplatzer plug with resolution of her symptoms. DISCUSSION: PAVM can be congenital or acquired, with the former being more common. Majority of the congenital PAVM's are associated with hereditary hemorrhagic telangiectasia (HHT)1. PAVM may be asymptomatic or present with a classic triad of dyspnea, cyanosis and clubbing. Hemoptysis can occur from intrabronchial rupture of PAVM or endobronchial telangiectasia. Pregnancy has been associated with an increased rate of PAVM growth and its associated complications2. A high index of suspicion is needed for diagnosis. Diagnosis is made by CTA, calculation of shunt fraction and contrast echocardiography. Treatment options include embolotherapy3 or lung resection if embolization fails. CONCLUSIONS: 1. PAVM are rare causes of hemoptysis, stroke and hypoxia 2. Identification is important due to association with Hereditary Hemorrhagic Telangiectasia and associated complications 3. PAVM tend to increase in size and be more symptomatic during pregnancy 4. Embolization of the feeding artery is highly effective in treatment. Reference #1: Khurshid I, Downie GH. Pulmonary arteriovenous malformation. Postgrad Med J. 2002;78(918):191-197. Reference #2: Esplin MS, Varner MW. Progression of pulmonary arteriovenous malformation during pregnancy: case report and review of the literature. Obstet Gynecol Surv. 1997;52(4):248-253. Reference #3: Lee DW, White RI, Jr., Egglin TK, et al. Embolotherapy of large pulmonary arteriovenous malformations: long-term results. Ann Thorac Surg. 1997;64(4):930-939; discussion 939-940. DISCLOSURE: The following authors have nothing to disclose: Rahul Mutneja, Aaron Glucksman, Tapas Bandyopadhyay No Product/Research Disclosure Information