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Treatment of Recurrent Pulmonary Arteriovenous Malformations: Comparison of Proximal Versus Distal Embolization Technique

  • Lucas R. Cusumano
  • Gary R. Duckwiler
  • Dustin G. Roberts
  • Justin P. McWilliamsEmail author
Clinical Investigation Arterial Interventions
Part of the following topical collections:
  1. Arterial Interventions

Abstract

Purpose

To examine the characteristics of recurrent pulmonary arteriovenous malformations (PAVMs) and compare the success of proximal versus distal embolization technique for treatment of recanalized PAVMs.

Materials

Between July 2007 and October 2018, 26 consecutive patients underwent embolization of 64 previously treated recurrent PAVMs at a single center with imaging follow-up. PAVM angioarchitecture was classified as either simple (1 feeding artery) or complex (≥ 2 feeding arteries). The mechanism of recurrence was characterized as recanalization (flow through previously placed embolic material) or reperfusion (flow through accessory arteries). For recanalized PAVMs, we compared embolizing proximal to or within the existing embolic (proximal embolization technique) versus embolizing distal to the existing embolic (distal embolization technique). Follow-up imaging was reviewed to determine treatment success, defined as decrease of the draining vein or sac size by at least 70%.

Results

Mean patient age was 47.6 years (range 22–72 years), and 61.5% were female. Twenty-four patients (92.3%) had hereditary hemorrhagic telangiectasia, a disorder associated with PAVM formation. 31/64 (48.4%) PAVMs were simple, and 33/64 (51.6%) PAVMs were complex. Recanalization was the most common pattern of recurrence, occurring in 54/64 (84.4%) PAVMs. Treatment success following repeat embolization was 54.7% at a mean follow-up time of 1.6 years. For recanalized PAVMs, treatment success was significantly more likely with distal embolization technique (14/15, 93.3%) than with proximal embolization technique (19/33, 57.6%) (P = 0.0180).

Conclusion

Recurrent PAVMs are difficult to treat, with high rates of recurrence following repeat embolization. Distal embolization technique is more likely to produce durable occlusion than proximal embolization.

Keywords

Pulmonary arteriovenous malformations Recanalization Reperfusion Embolization Hereditary hemorrhagic telangiectasia 

Notes

Funding

This study was not supported by any funding.

Compliance with Ethical Standards

Conflict of interest

Gary R Duckwiler, MD, is a scientific advisor for Sequent Medical, pipeline proctor for Medtronic, and scientific advisor for Neurvana. Justin P. McWilliams, MD, is a scientific advisor for Boston Scientific, Penumbra, and Merit Medical.

Ethical Approval

For this type of study, formal consent is not required.

Informed Consent

This study has obtained IRB approval from the UCLA IRB, and the need for informed consent was waived.

Consent for Publication

For this type of study, consent for publication is not required.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  1. 1.Division of Interventional Radiology, Department of RadiologyDavid Geffen School of Medicine at UCLALos AngelesUSA

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