Clinical study
Embolization of Pulmonary Arteriovenous Malformations with Amplatzer Vascular Plugs: Safety and Midterm Effectiveness

https://doi.org/10.1016/j.jvir.2010.01.026Get rights and content

Purpose

To evaluate the safety and effectiveness of Amplatzer vascular plugs (AVPs) for percutaneous closure of arteries feeding pulmonary arteriovenous malformations (PAVMs).

Materials and Methods

Over a 45-month period, 24 consecutive patients with at least one PAVM treated with an AVP were selected from a database on patients with a PAVM who received embolotherapy. Immediate technical success was defined as the complete absence of flow through the PAVM after embolization without the need for additional embolization material. Success on follow-up imaging was defined as a reduction in size of at least 70% of the aneurysm or draining vein on follow-up computed tomography or the absence of flow through the PAVM on a subsequent pulmonary angiogram.

Results

Thirty-seven AVPs were used to close 36 feeding arteries in 35 PAVMs in seven male and 17 female patients aged 11–86 years (mean age, 50 y). Technical success was achieved in 35 feeding arteries (97%). One feeding artery required two AVPs for closure. There were no immediate procedure-related complications. At a mean clinical follow-up of 322 days (range, 1–1,126 d), all patients were alive without new PAVM-related complications. Imaging follow-up was available for 29 embolized vessels (81%) with a mean follow-up of 418 days (range, 40–937 d), and recanalization occurred in two treated vessels (7%).

Conclusions

AVPs are safe and effective for closure of PAVMs feeding vessels that can be reached with a guiding catheter, with an acceptable rate of recanalization.

Section snippets

Population

This retrospective Health Insurance Portability and Accountability Act–compliant study was conducted in three academic medical centers and approved by all institutional review boards. We included all consecutive patients with AVP embolization of PAVMs from a database of patients who received embolotherapy between December 2005 and September 2009. These were not consecutive PAVMs treated in these centers as other embolic agents were also used at that time, namely coils and detachable balloons.

Results

Twenty-four patients underwent PAVM embolization with the AVP device. Seven (29%) were male and 17 (71%) were female, and patients' ages ranged from 11 to 86 years (mean, 50 y). Nineteen patients (79%) had possible or definite HHT based on clinical criteria. Seven patients (29%) had earlier complications related to PAVM (three had earlier strokes, three had transient ischemic attacks [TIAs], and one had cerebral abscess). Nineteen patients (79%) were assessed in a dedicated HHT clinic.

A total

Discussion

The introduction of AVPs in the PAVM treatment armamentarium has created much debate regarding the best tool to occlude these lesions (2, 17, 18). Currently, the standard treatment of these fistulas is coil embolization, and balloon use has decreased as a result of limited availability.

Not all feeding arteries were amenable to PAVM treatment, mainly because tortuous and angulated feeding arteries could not be safely catheterized to place the AVP close enough to the PAVM. Therefore, AVPs and

References (29)

  • A.D. Kjeldsen et al.

    Pulmonary arteriovenous malformations: screening procedures and pulmonary angiography in patients with hereditary hemorrhagic telangiectasia

    Chest

    (1999)
  • M. Hinterseer et al.

    Interventional embolization of a giant pulmonary arteriovenous malformation with right-left-shunt associated with hereditary hemorrhagic telangiectasia

    Clin Res Cardiol

    (2006)
  • C. Ferro et al.

    Percutaneous transcatheter embolization of a large pulmonary arteriovenous fistula with an Amplatzer vascular plug

    Cardiovasc Intervent Radiol

    (2007)
  • A. Beck et al.

    Transcatheter closure of pulmonary arteriovenous malformations with Amplatzer devices

    Cathet Cardiovasc Interv

    (2006)
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    G.S. is the recipient of a senior research scholarship from Fonds de la Recherche en Santé du Québec (FRSQ). M.E.F. has received financial support from the Nelson Arthur Hyland Foundation and the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. None of the authors have identified a conflict of interest.

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