Limits...
Embolotherapy for pulmonary arteriovenous malformations in patients without hereditary hemorrhagic telangiectasia.

Shin JH, Park SJ, Ko GY, Yoon HK, Gwon DI, Kim JH, Sung KB - Korean J Radiol (2010)

Bottom Line: For the 13 patients with available data, the mean arterial O(2) saturation changed significantly from 92% to 98%.In these 33 embolized PAVMs, the mean sac diameter significantly decreased from 17.83 mm to 0.68 mm.Sporadic PAVMs are mostly the simple type with predominance in the lower lobe and peripheral locations.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. jhshin@amc.seoul.kr

ABSTRACT

Objective: To evaluate the clinical and radiological outcomes of transcatheter embolotherapy for treating sporadic pulmonary arteriovenous malformations (PAVMs) that were not associated with hereditary hemorrhagic telangiectasia.

Materials and methods: Between January 2001 and June 2008, thirty-five sporadic PAVMs were detected in 23 patients. The clinical follow up consisted of assessing the changes of the signs and symptoms of the PAVMs, and radiological evaluation with chest radiographs or chest CT scans.

Results: The lower lung regions (63%) and peripheral locations (86%) were the common locations of the PAVMs. Thirty-four PAVMs (97%) had simple architecture (one arterial feeder within a single pulmonary segment). Technical success was achieved in 33 PAVMs (94%); two cases of technical failure were due to catheterization failure (n = 1) and too large a feeding artery (17 mm) that disabled embolotherapy (n = 1). Coils and Amplatz vascular plugs were used in 30 and three PAVMs, respectively. Inadvertent placement of one coil (n = 1) and pulmonary infarction (n = 1) occurred, but no relevant symptoms developed. For the 13 patients with available data, the mean arterial O(2) saturation changed significantly from 92% to 98%. Complete or near-complete involution of the sac was observed in 30 of the 33 embolized PAVMs (91%). In these 33 embolized PAVMs, the mean sac diameter significantly decreased from 17.83 mm to 0.68 mm.

Conclusion: Sporadic PAVMs are mostly the simple type with predominance in the lower lobe and peripheral locations. Transcatheter embolotherapy with coils or Amplatz vascular plugs is a safe and effective treatment for sporadic PAVMs and this provides excellent functional and radiological improvement.

Show MeSH

Related in: MedlinePlus

40-year-old female with large pulmonary arteriovenous malformation in left lower lobe (Patient No. 6). Simple radiograph (A), left selective pulmonary arteriogram (B), and CT angiogram (C) show large 32-mm-diameter pulmonary arteriovenous malformation (arrows) with single arterial feeder (arrowheads in C) and single draining vein. Left pulmonary arteriogram (D) after embolotherapy with placing four Nester coils shows no evidence of pulmonary arteriovenous malformation. Simple radiograph (E) 19 months after embolotherapy shows complete disappearance of pulmonary arteriovenous malformation shadow.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2864858&req=5

Figure 1: 40-year-old female with large pulmonary arteriovenous malformation in left lower lobe (Patient No. 6). Simple radiograph (A), left selective pulmonary arteriogram (B), and CT angiogram (C) show large 32-mm-diameter pulmonary arteriovenous malformation (arrows) with single arterial feeder (arrowheads in C) and single draining vein. Left pulmonary arteriogram (D) after embolotherapy with placing four Nester coils shows no evidence of pulmonary arteriovenous malformation. Simple radiograph (E) 19 months after embolotherapy shows complete disappearance of pulmonary arteriovenous malformation shadow.

Mentions: Of the 35 PAVMs, 33 (32 simple and one diffuse) were successfully embolized with no residual filling, making the technical success rate 94% (Figs. 1, 2). Twenty-two patients had one session of embolotherapy, while one patient received two sessions of embolotherapy because there were nine PAVMs in both lungs. One to twenty three coils were used for 29 simple PAVMs (average, 5.4 per PAVM), whereas 54 coils were used for the one diffuse type PAVM. Amplatz vascular plugs (6 or 12 mm in diameter) were used for three simple PAVMs, which had feeding artery diameters of 3, 8 and 10 mm (Fig. 2). Each PAVM required only one vascular plug, with complete or near-complete obliteration of the sac observed during follow up. The vascular plug was oversized 30-50% greater than the feeding artery diameter.


Embolotherapy for pulmonary arteriovenous malformations in patients without hereditary hemorrhagic telangiectasia.

Shin JH, Park SJ, Ko GY, Yoon HK, Gwon DI, Kim JH, Sung KB - Korean J Radiol (2010)

40-year-old female with large pulmonary arteriovenous malformation in left lower lobe (Patient No. 6). Simple radiograph (A), left selective pulmonary arteriogram (B), and CT angiogram (C) show large 32-mm-diameter pulmonary arteriovenous malformation (arrows) with single arterial feeder (arrowheads in C) and single draining vein. Left pulmonary arteriogram (D) after embolotherapy with placing four Nester coils shows no evidence of pulmonary arteriovenous malformation. Simple radiograph (E) 19 months after embolotherapy shows complete disappearance of pulmonary arteriovenous malformation shadow.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2864858&req=5

Figure 1: 40-year-old female with large pulmonary arteriovenous malformation in left lower lobe (Patient No. 6). Simple radiograph (A), left selective pulmonary arteriogram (B), and CT angiogram (C) show large 32-mm-diameter pulmonary arteriovenous malformation (arrows) with single arterial feeder (arrowheads in C) and single draining vein. Left pulmonary arteriogram (D) after embolotherapy with placing four Nester coils shows no evidence of pulmonary arteriovenous malformation. Simple radiograph (E) 19 months after embolotherapy shows complete disappearance of pulmonary arteriovenous malformation shadow.
Mentions: Of the 35 PAVMs, 33 (32 simple and one diffuse) were successfully embolized with no residual filling, making the technical success rate 94% (Figs. 1, 2). Twenty-two patients had one session of embolotherapy, while one patient received two sessions of embolotherapy because there were nine PAVMs in both lungs. One to twenty three coils were used for 29 simple PAVMs (average, 5.4 per PAVM), whereas 54 coils were used for the one diffuse type PAVM. Amplatz vascular plugs (6 or 12 mm in diameter) were used for three simple PAVMs, which had feeding artery diameters of 3, 8 and 10 mm (Fig. 2). Each PAVM required only one vascular plug, with complete or near-complete obliteration of the sac observed during follow up. The vascular plug was oversized 30-50% greater than the feeding artery diameter.

Bottom Line: For the 13 patients with available data, the mean arterial O(2) saturation changed significantly from 92% to 98%.In these 33 embolized PAVMs, the mean sac diameter significantly decreased from 17.83 mm to 0.68 mm.Sporadic PAVMs are mostly the simple type with predominance in the lower lobe and peripheral locations.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. jhshin@amc.seoul.kr

ABSTRACT

Objective: To evaluate the clinical and radiological outcomes of transcatheter embolotherapy for treating sporadic pulmonary arteriovenous malformations (PAVMs) that were not associated with hereditary hemorrhagic telangiectasia.

Materials and methods: Between January 2001 and June 2008, thirty-five sporadic PAVMs were detected in 23 patients. The clinical follow up consisted of assessing the changes of the signs and symptoms of the PAVMs, and radiological evaluation with chest radiographs or chest CT scans.

Results: The lower lung regions (63%) and peripheral locations (86%) were the common locations of the PAVMs. Thirty-four PAVMs (97%) had simple architecture (one arterial feeder within a single pulmonary segment). Technical success was achieved in 33 PAVMs (94%); two cases of technical failure were due to catheterization failure (n = 1) and too large a feeding artery (17 mm) that disabled embolotherapy (n = 1). Coils and Amplatz vascular plugs were used in 30 and three PAVMs, respectively. Inadvertent placement of one coil (n = 1) and pulmonary infarction (n = 1) occurred, but no relevant symptoms developed. For the 13 patients with available data, the mean arterial O(2) saturation changed significantly from 92% to 98%. Complete or near-complete involution of the sac was observed in 30 of the 33 embolized PAVMs (91%). In these 33 embolized PAVMs, the mean sac diameter significantly decreased from 17.83 mm to 0.68 mm.

Conclusion: Sporadic PAVMs are mostly the simple type with predominance in the lower lobe and peripheral locations. Transcatheter embolotherapy with coils or Amplatz vascular plugs is a safe and effective treatment for sporadic PAVMs and this provides excellent functional and radiological improvement.

Show MeSH
Related in: MedlinePlus