Vessel Embolization: Transcatheter Embolization of Pulmonary Arteriovenous Malformations and Aortopulmonary Collateral Arteries
Pulmonary arteriovenous malformations (PAVMs) are abnormal direct communications between the pulmonary artery and vein, allowing an intrapulmonary right-to-left shunt. Significant PAVMs can result in systemic hypoxemia with exertional dyspnea, paradoxical embolization with stroke, brain abscesses, and pulmonary hemorrhage with massive hemoptysis. Aortopulmonary collateral arteries (APCs) are frequently present in patients with cyanotic congenital heart disease and reduced pulmonary blood flow. Large or multiple collaterals can result in pulmonary overperfusion and symptomatic cardiac volume overload. Transcatheter embolization has been established as the preferred treatment for both PAVMs and APCs.
KeywordsPulmonary arteriovenous malformation Aortopulmonary collateral arteries Embolization Transcatheter therapy Vascular plug
Patient 1. The VER135° angiographic catheter was then exchanged for an 8 Fr, 80-cm long delivery sheath through which a 100 cm, 7 Fr Judkins Right 3.5 guide catheter was introduced. The guide catheter was then advanced as distally as possible within the feeding vessel beyond any branches to the normal lung (AVI 15365 kb)
Patient 1. A 12 mm AVP I (AGA Medical Corporation, Minnesota) was selected so as to be 50% larger than the target vessel and was delivered through the guide catheter to the feeding vessel. Selective arteriogram after deployment of the AVP in the feeding vessel showed near-complete occlusion of the left upper PAVM (AVI 23814 kb)
Patient 1. Repeated selective arteriogram a 5 min later after the device release documented the AVP I in good position with no residual flow into the left upper PAVM. Upon deployment of the AVP, her peripheral arterial oxygen saturation improved from 86 to 93% at rest. Due to the length of the procedure and the amount of contrast given, no further embolization attempts to another PAVM were performed (AVI 24070 kb)