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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.

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Related in: MedlinePlus

28-year-old male with small pulmonary arteriovenous malformation in right lower lobe (Patient No. 11). Right pulmonary arteriogram (A) shows small pulmonary arteriovenous malformation (arrows) with single arterial feeder and single draining vein. Right pulmonary arteriogram (B) after embolotherapy with placing two Nester coils shows no evidence of pulmonary arteriovenous malformation. Follow-up CT scan (C) after three weeks shows pulmonary infarction (arrows) distal to embolized pulmonary artery.
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Figure 3: 28-year-old male with small pulmonary arteriovenous malformation in right lower lobe (Patient No. 11). Right pulmonary arteriogram (A) shows small pulmonary arteriovenous malformation (arrows) with single arterial feeder and single draining vein. Right pulmonary arteriogram (B) after embolotherapy with placing two Nester coils shows no evidence of pulmonary arteriovenous malformation. Follow-up CT scan (C) after three weeks shows pulmonary infarction (arrows) distal to embolized pulmonary artery.

Mentions: During embolotherapy, one coil was inadvertently placed into the right upper pulmonary artery without any symptomatic change in one patient (No. 5 in Table 1). In another patient (No. 11 in Table 1), a follow-up CT scan three weeks after embolotherapy showed a pulmonary infarction distal to the embolized pulmonary artery (Fig. 3). His vague right chest pain subsided within several days, and pleurisy did not develop.


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)

28-year-old male with small pulmonary arteriovenous malformation in right lower lobe (Patient No. 11). Right pulmonary arteriogram (A) shows small pulmonary arteriovenous malformation (arrows) with single arterial feeder and single draining vein. Right pulmonary arteriogram (B) after embolotherapy with placing two Nester coils shows no evidence of pulmonary arteriovenous malformation. Follow-up CT scan (C) after three weeks shows pulmonary infarction (arrows) distal to embolized pulmonary artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: 28-year-old male with small pulmonary arteriovenous malformation in right lower lobe (Patient No. 11). Right pulmonary arteriogram (A) shows small pulmonary arteriovenous malformation (arrows) with single arterial feeder and single draining vein. Right pulmonary arteriogram (B) after embolotherapy with placing two Nester coils shows no evidence of pulmonary arteriovenous malformation. Follow-up CT scan (C) after three weeks shows pulmonary infarction (arrows) distal to embolized pulmonary artery.
Mentions: During embolotherapy, one coil was inadvertently placed into the right upper pulmonary artery without any symptomatic change in one patient (No. 5 in Table 1). In another patient (No. 11 in Table 1), a follow-up CT scan three weeks after embolotherapy showed a pulmonary infarction distal to the embolized pulmonary artery (Fig. 3). His vague right chest pain subsided within several days, and pleurisy did not develop.

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