Embolotherapy of Pulmonary Arteriovenous Malformations: Long-term Results in 112 Patients

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PURPOSE

To evaluate the long-term results of embolotherapy of pulmonary arteriovenous malformations (PAVMs) in a large group of patients.

MATERIALS AND METHODS

Between July 1988 and August 2001, 134 consecutive patients underwent embolotherapy of PAVMs with feeding arteries larger than 3 mm or that had previously caused bleeding or systemic complications. The mean follow-up was 62.2 months. The primary endpoints of the study were the efficacy of embolotherapy, decrease in right-to-left shunt, and increase in partial arterial oxygen pressure (PaO2); the secondary endpoint was the prevalence of complications. Standard follow-up consisted of yearly history, chest radiography, and arterial blood gas measurement.

RESULTS

Follow-up was available in 112 patients. Initially, 296 PAVMs were embolized in these patients. Nineteen patients (17%) underwent a second procedure and four patients underwent a third procedure because of recanalization of originally occluded feeding arteries (25 PAVMs, 8%) or interval enlargement of untreated PAVMs (53 PAVMs). In total, 349 PAVMs were embolized in 157 sessions. The mean diameter of occluded vessels was 4.7 mm. The long-term outcomes of embolotherapy were successful in 83% of patients overall and in 96% of patients in whom all angiographically visible PAVMs were embolized. Recanalization occurred in 12 of 16 patients who underwent repeat treatment because of enlargement of nonembolized PAVMs. Postprocedural pleurisy occurred after 14 of 157 sessions (9%). Periprocedural complications occurred in 12 sessions (8%) and included migration of an embolic device, transient ischemic attack (TIA), angina pectoris, and early cerebral infarction after embolization. Three patients experienced TIA and two patients experienced a cerebral abscess during follow-up after embolotherapy.

CONCLUSIONS

Embolotherapy of PAVMs is efficacious and durable in the majority of patients. Patients should remain under regular review because recanalization of PAVMs or enlargement of untreated PAVMs can occur years after treatment.

Section snippets

MATERIALS AND METHODS

The study was performed after approval of the medical review board of our hospital.

Overall Results

The study group consisted of 112 patients, 44 men and 68 women, with a mean age of 44.9 years (range, 7–85 years). The mean follow-up was 62.2 months (range, 9 –145 months). Initially, 296 PAVMs were embolized in one or two sessions in 110 patients and in three sessions in two patients. Nineteen patients underwent a second treatment and four underwent a third. In total, 349 PAVMs were embolized in 157 sessions.

The mean value of right-to-left shunts decreased from 18.5% (SD, 8.6%) to 7.3% (SD,

DISCUSSION

The goals of treatment of PAVMs are prevention of hemorrhage, improvement of hypoxemia, and, most importantly, prevention of the complications that are associated with the local absence of the pulmonary capillary filter. It is estimated that 24% of patients with PAVMs experience TIA or stroke and 9% experience cerebral abscess on presentation of PAVMs (1). In 76 consecutive patients, White and colleagues (5) reported TIAs in 37%, strokes in 18%, and cerebral abscesses in 9% before

Acknowledgments

The authors thank P. Zanen for his help in the statistical analysis.

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    This study was financially supported by the Janivo Foundation, the Mr. Willem Bakhuys Roozeboom Foundation, and Glaxo SmithKline, The Netherlands. None of the authors have identified a conflict of interest.

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