Endovascular Embolisation of Pulmonary Arteriovenous Malformation Using Amplatzer Vascular Plugs

Abstract

Pulmonary arteriovenous malformation (PAVMs) are abnormal communications between pulmonary arteries and veins. The rarity of their occurrence, coupled with the risks they pose, including brain abscess, embolic stroke, and myocardial infarction, mandates that they should not be overlooked in the differential diagnosis of patients presenting with haemoptysis, dyspnea, clubbing, cyanosis, hypoxemia, or epistaxis. We present the case of a 41-year-old local female who presented to our hospital as an outpatient with decreased oxygen saturation (SpO 2 ) of 70%-80% for the past two years with a final diagnosis of PAVM. The initial baseline workup showed polycythemia with a hemoglobin level of 19 mg/dL and raised hematocrit. She had extensive workup in the past two years for her polycythemia including gene mutation testing and cardiac workup which all turned out normal. Her chest X-ray (CXR) showed right lung opacity which was initially considered to be infective but it did not respond to antibiotic treatment. Later on, a CT scan of the chest was performed and findings were typical of a large PAVM which had two feeding arteries. The patient was referred to a cardiothoracic surgeon who sent the patient to the interventional radiology section for endovascular management. The embolization procedure was then performed and both feeders were successfully embolised. After the procedure, the patient's SpO 2 levels were restored to 95%-96%, and no post-procedure complications were noted.

Pulmonary Arteriovenous Malformation Unmasked by Pregnancy: A Review of Pulmonary Arteriovenous Malformations and Cardiovascular and Respiratory Changes in Pregnancy

“…The two main treatment options for PAVM are surgical resection (in various extents and surgical approaches) and percutaneous endovascular embolotherapy of the feeding vessel by coils or plugs/balloons (treatment of choice), with each method bearing some advantages, disadvantages, and complications [ 26 ].…”

The Role of Interventional Radiology in the Diagnosis and Treatment of Pulmonary Arteriovenous Malformations

“…In view of the right to left shunt, another potentially life-threatening complication is systemic air embolism [ 18 ]. Air embolisms can result from air bubbles trapped in the catheter hub being advanced along with wire or aspirated from the end of a catheter open to the air.…”

“…Post-procedure, the most common early complications are pleuritic chest pain [ 18 ] and blood-stained sputum. These are usually self-limiting [ 5 ].…”