Persistence After Treatment of Pulmonary Arteriovenous Malformations in Children

Excerpt

Pulmonary arteriovenous malformations (pAVMs) are commonly found in children with hereditary hemorrhagic telangiectasia (HHT) with a 59% prevalence of pAVM either at the time of their HHT diagnosis or upon subsequent follow-up [1]. As opposed to the adult population where HHT practice guidelines advise treating all pulmonary arteriovenous malformations (pAVM) with feeding arteries > 2 mm, current guidelines for children recommend treating only large or symptomatic pAVMs [2]. This is due to the child’s growth leading to concurrent growth of the feeding artery/nidus. Past data has shown that this can lead to high rates of post-embolization persistence and conversion of simple pAVMs to complex pAVMs [3]. However, none of the existing evidence assesses the effects of embolic agent selection on persistence rates. In this study we assessed persistence rates after pAVM embolization with three common embolic (detachable coils, uncovered nitinol plugs, and covered plugs) in pediatric patients from our HHT center. Our institutional review board approved this retrospective study. We reviewed pediatric patients who underwent pAVM embolization with detachable coils, microvascular plugs (MVP™ system) or Amplatzer vascular plugs (AVP™) at an academic tertiary care hospital from 2003 to 2020. Only pediatric patients with follow-up chest computed tomography pulmonary angiograms (CTPAs) were included. Two experienced interventional radiologists (SEM, and CRF, with 35 and 13 years’ experience respectively) confirmed persistence after reviewing the follow up CTPA images. Persistence was defined as a < 70% reduction in pAVM sac size or contrast enhancement of the sac after embolization on followup CTA. Simple descriptive statistics were used to assess the differences in persistence between different embolic devices. …