Comparison of Feeding-Artery-Only versus Nidus-Plus-Feeding-Artery Embolization of Pulmonary Arteriovenous Malformations

Roberts, Dustin G.; Sparks, Hiro; Cusumano, Lucas R.; Mathevosian, Sipan; Duckwiler, Gary; McWilliams, J.

doi:10.1016/j.jvir.2021.01.271

Cited by 20 publications

(10 citation statements)

References 36 publications

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“…15 In the present meta-analysis, ≥70% reduction in draining vein/sac diameter was taken as a surrogate marker for completeness of occlusion according to the previously described computed tomography (CT) criteria by Lee et al and also adopted by 2 of the included studies. 5,6,16 This does not necessarily implicate cessation of flow with a possible residual risk of paradoxical-embolism-related events. However, using this threshold, there were no reports of events as stroke, transient ischemic attack, or brain abscess in 298 embolized PAVMs.…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, additional 2 studies comparing VSE with FAE versus FAE alone have been published. 6,7 To the best of our knowledge, the safety and efficacy of VSE (with or without FAE) versus FAE alone in the management of PAVMs have not been systematically evaluated. Hence, the present systematic review and meta-analysis sought to evaluate the safety and efficacy of VSE vis-à-vis FAE in patients with PAVMs.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Venous Sac Embolization With or Without Feeding Artery Embolization Versus Feeding Artery Embolization Alone in the Management of Pulmonary Arteriovenous Malformations: A Systematic Review and Meta-analysis

et al. 2022

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Purpose: To evaluate by meta-analysis the safety and efficacy of venous sac embolization (VSE) with or without feeding artery embolization versus feeding artery embolization (FAE) alone in the management of pulmonary arteriovenous malformations (PAVMs). Methods: This systematic review and meta-analysis was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search was performed in MEDLINE, Embase, and Scopus till August 31, 2021 to identify studies comparing the safety and efficacy of VSE with or without FAE versus FAE alone in PAVMs. The success of treatment was assessed by comparing the number of PAVMs with ≥70% decrease in the size of draining vein/sac between the 2 groups. The pooled odds ratio (OR) and 95% confidence interval (95% CI) were calculated using the random-effects inverse-variance model and were used to compare pooled therapeutic efficacy between the groups. Results: Three studies were found eligible for the meta-analysis. The included studies had a total of 169 patients (119 females and 50 males). The total number of PAVMs was 298, and hereditary hemorrhagic telangiectasia was present in 119 patients. The success of treatment was higher with VSE as compared to FAE (OR=3.54, 95% CI=1.66–7.56). The minor complications were similar in both groups, and one major complication occurred in the FAE group. More coils were used in the VSE group. Conclusions: The present systematic review and meta-analysis has consolidated the evidence that VSE with or without FAE is more efficacious than FAE alone in the management of PAVMs without any increase in the associated risk of sac rupture or coil migration. Clinical Impact Until high-quality data from a prospective, multicentric, randomized controlled trial becomes available, the evidence consolidated by the present systematic review and meta-analysis showing the efficacy of venous sac embolization (with or without feeding artery embolization) over feeding artery embolization alone, can be used for clinical decision-making in the management of pulmonary arterio-venous malformations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Venous Sac Embolization With or Without Feeding Artery Embolization Versus Feeding Artery Embolization Alone in the Management of Pulmonary Arteriovenous Malformations: A Systematic Review and Meta-analysis

et al. 2022

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“…In AVM embolization, coils and covered stents should not be used to obstruct the feeding artery because they are ineffective in reducing venous hypertension and can promote collateral circulation and lesion development. 52 …”

Section: Treatment Of Avmsmentioning

confidence: 99%

Overview of peripheral arteriovenous malformations: From diagnosis to treatment methods

Shen,

Su,

Wang

et al. 2023

Journal of Interventional Medicine

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“…58 However, recent studies have challenged that idea showing better persistent occlusion with embolization of the sac and distal feeding pulmonary artery. 59 It is unclear if this is due to increased volume of embolic material, decreased risk of reperfusion due to sac embolization, or the morphology of the PAVMs that are amenable to this technique.…”

Section: Embolizationmentioning

confidence: 99%

Pulmonary Arteriovenous Malformations: What the Interventional Radiologist Should Know

Kaufman

McDonald

Balch

et al. 2022

Semin intervent Radiol

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Pulmonary arteriovenous malformations (PAVMs) are abnormal connections between the pulmonary artery and pulmonary vein bypassing the normal capillary bed causing a right-to-left shunt. The majority (80–90%) of PAVMs are associated with hereditary hemorrhagic telangiectasia (HHT). PAVMs may be asymptomatic or present with symptoms of hypoxia, shortness of breath, migraines, sequelae of paradoxical embolization, or rupture. Transcatheter embolization has become the standard of care. This article will review the clinical presentation, workup, genetics, imaging findings, embolization, complications, and follow-up for patients with PAVMs.

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Comparison of Feeding-Artery-Only versus Nidus-Plus-Feeding-Artery Embolization of Pulmonary Arteriovenous Malformations

Cited by 20 publications

References 36 publications

Efficacy and Safety of Venous Sac Embolization With or Without Feeding Artery Embolization Versus Feeding Artery Embolization Alone in the Management of Pulmonary Arteriovenous Malformations: A Systematic Review and Meta-analysis

Efficacy and Safety of Venous Sac Embolization With or Without Feeding Artery Embolization Versus Feeding Artery Embolization Alone in the Management of Pulmonary Arteriovenous Malformations: A Systematic Review and Meta-analysis

Overview of peripheral arteriovenous malformations: From diagnosis to treatment methods

Pulmonary Arteriovenous Malformations: What the Interventional Radiologist Should Know

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