Bilateral Multiple Pulmonary Arteriovenous Malformations: Endovascular Treatment with the Amplatzer Vascular Plug

Çil, Barbaros; Canyiğit, Murat; Özkan, Orhan Ş.; Pamuk, Gulsun A.; Doğan, Rıza

doi:10.1097/01.rvi.0000186954.74462.ce

Cited by 70 publications

(35 citation statements)

References 7 publications

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“…Transcatheter vaso-occlusion of PAVMs using detachable steel coils (‘embolization therapy’) has become the mainstay of treatment, obviating the need for surgery in the majority of cases [18]. Other devices are no longer routinely used, with the exception of PAVMs with very large feeding vessels (up to 14 mm), which may require specific devices such as detachable balloons or Amplatzer occluders, in order to avoid paradoxical embolization of material [118,119,120,121,122]. …”

Section: Treatment Of Pavmsmentioning

confidence: 99%

Pulmonary Vascular Manifestations of Hereditary Hemorrhagic Telangiectasia (Rendu-Osler Disease)

et al. 2007

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Hereditary hemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber disease is a genetic disorder with autosomal dominance and variable penetrance, characterized by epistaxis, telangiectasia and visceral manifestations of the disease. The estimated minimal prevalence is 1/10,000 inhabitants. The diagnosis is established on clinical criteria, and may be further confirmed by the identification of causative mutations in either the ENG or the ACVRL1 gene coding for endoglin and ALK1, respectively. Pulmonary vascular manifestations of HHT include pulmonary arteriovenous malforma- tions (PAVMs; especially in patients with ENG mutations) and less frequently pulmonary hypertension (especially in patients with ACVRL1 mutations). In 15–33% of patients with HHT, PAVMs consist of abnormal communications between pulmonary arteries and pulmonary veins, causing right-to-left shunting, and thus, frequently hypoxemia and dyspnea on exertion, although PAVMs may remain asymptomatic and frequently undiagnosed unless complications occur. PAVMs result in severe and frequent complications often at a young age, which may reveal the diagnosis, e.g. transient ischemic attack and cerebral stroke (10–19% of patients), systemic severe infections and abscesses (including cerebral abscess in 5–19% of patients), and rarely massive hemoptysis or hemothorax. Infections in HHT are related to the right-to-left shunting that bypasses the pulmonary capillaries and facilitates the passage of septic or aseptic emboli into the systemic and especially cerebral circulation, and potentially to minor defects in innate immunity. Treatment of PAVMs based on transcatheter coil vaso-occlusion of the feeding artery significantly decreases right-to-left shunting, hypoxemia and dyspnea on exertion, and reduces the risk of systemic complications. Long-term follow-up is warranted after transcatheter vaso-occlusion of PAVMs due to frequent recanalization of treated PAVMs and development or growth of untreated PAVMs. Patients with HHT should be informed of the risk of PAVM and potentially severe complications occurring in heretofore asymptomatic subjects. All adult patients with HHT should be proposed systematic screening for PAVM, by contrast echocardiography (preceded by anteroposterior chest radiograph) or computed tomography of the chest. Pulmonary hypertension is rare in HHT, and may be due either to systemic arteriovenous shunting in the liver increasing cardiac output or be clinically and histologically indistinguishable from idiopathic pulmonary arterial hypertension. Pulmonary hypertension is detected by systematic examination of right cardiac cavities and tricuspid regurgitation flow at echocardiography, and the diagnosis is established by right heart catheterization.

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Section: Treatment Of Pavmsmentioning

confidence: 99%

Pulmonary Vascular Manifestations of Hereditary Hemorrhagic Telangiectasia (Rendu-Osler Disease)

et al. 2007

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“…Amplatzer vascular plug (AVP) has been used for transcatheter embolizations in peripheral vasculature; occlusion of abnormal vessel communications and other neurovascular conditions 4,5 . we describe endovascular AVP treatment of CB presenting with life-threatening hemoptysis.…”

Section: Introductionmentioning

confidence: 99%

Amplatzer Vascular Plug for Occlusion of Parent Artery in Carotid Blowout with Active Extravasation

2011

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Carotid blowout is a devastating complication in patients with head and neck malignancy. Various treatments including high risk surgery, carotid stenting or carotid occlusion using either coils or detachable balloons have been described. The key for any treatment is the rapidity at which it can be performed. We describe treatment of common carotid blowout secondary to neoplastic infiltration using four Amplatzer vascular plugs deployed in less than ten minutes.

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“…Successful use of AVP and AVP 2 for embolotherapy of PAVMs has been reported in several studies (8,(12)(13)(14)(15)(16)(17). Compared with the AVP device, the AVP 2 has multiple layers of finer, more densely woven nitinol mesh and a multisegmented design, which theoretically increases its thrombogenic effect and decreases the OT (9).…”

Section: Discussionmentioning

confidence: 99%

Does the type and size of Amplatzer vascular plug affect the occlusion time of pulmonary arteriovenous malformations?

Elantably²

2017

Diagn Interv Radiol

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P ulmonary arteriovenous malformations (PAVMs) are abnormal direct fistulous communications between a pulmonary artery and a pulmonary vein, which may be present alone or in association with other vascular anomalies as in hereditary hemorrhagic telangiectasia (1, 2). As a result of this abnormal communication, a right to left shunt can develop and may lead to serious neurologic complications due to paradoxical embolization (2, 3).Introduced in 1977, transcatheter embolization is now the first line of management for PAVMs (4). Coils and amplatzer vascular plugs (AVP or AVP 2, St. Jude Medical) are the current endovascular approaches available. The occlusion time (OT) of an embolic device, which is defined as the time between the deployment of the device until complete occlusion of the artery, is of paramount importance, particularly in right-to-left shunt lesions such as PAVMs. The reason is that the thrombus formed on the surface of these embolic devices after deployment can migrate with the blood flow through the PAVM into the systemic circulation resulting in devastating complications related to paradoxical embolization (2, 5, 6).The OT of AVP devices in the treatment of PAVMs has been previously studied and the results documented its safety with an acceptable OT of 2-3 min without higher risk of systemic paradoxical embolization (8). Compared with the AVP device, the AVP 2 has a finer, more densely woven nitinol frame and a multisegmented design, which allows for increased length-wise expansion (9). Theoretically, this design should decrease the OT and have greater efficacy (10).The purpose of our study is to calculate the OT of AVP and AVP 2 used in treatment of PAVMs and correlate it to the type of the device used and the percent of device oversizing. Immediate technical success rates, persistence rates, and complications were also recorded for both devices. I N T E R V E N T I O N A L R A D I O LO G Y O R I G I N A L A R T I C L E PURPOSEOcclusion time (OT) is an important factor in the treatment of pulmonary arteriovenous malformations (PAVMs) since it can lead to serious complications. The purpose of our study is to calculate the OT of Amplatzer vascular plug (AVP, St Jude Medical), and correlate it to the type of the device used (AVP or AVP 2) and the percent of device oversizing. Technical success rates and complications were also recorded. METHODSWe retrospectively studied a total of 19 patients with 47 PAVMs who received percutaneous transcatheter embolization therapy using either AVP or AVP 2. We recorded the location, type, feeding artery diameter, AVP device used, and OT of each PAVM. We correlated the percent of device oversizing and the type of AVP with the OT. We also studied the rate of persistence of PAVM for both devices. RESULTSForty-six (98%) of the PAVMs were simple. Device diameters ranged from 4.0-16.0 mm with device oversizing ranging between 14% and 120%. There was a statistically significant difference in the OT of AVP and AVP 2 (3 min 54 s vs. 5 min 30 s, P = 0.030). There was a we...

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Bilateral Multiple Pulmonary Arteriovenous Malformations: Endovascular Treatment with the Amplatzer Vascular Plug

Cited by 70 publications

References 7 publications

Pulmonary Vascular Manifestations of Hereditary Hemorrhagic Telangiectasia (Rendu-Osler Disease)

Pulmonary Vascular Manifestations of Hereditary Hemorrhagic Telangiectasia (Rendu-Osler Disease)

Amplatzer Vascular Plug for Occlusion of Parent Artery in Carotid Blowout with Active Extravasation

Does the type and size of Amplatzer vascular plug affect the occlusion time of pulmonary arteriovenous malformations?

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