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

Abstract

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...

Chitosan-based liposomal thermogels for the controlled delivery of pingyangmycin: design, optimization andin vitroandin vivostudies

“…lung toxicity) of PYM have limited its wide application (Yang et al., 2012 ). As a substitute for traditional surgery, interventional embolization treatment for VM has been utilized more accurately and adaptably to block blood vessels in the past few years (Abdel Aal et al., 2017 ). Chemo-embolization method, which combines the advantages of embolic materials and therapeutic drugs, has become one of the promising treatments for VM recently (Ashrafi et al., 2017 ).…”