Endovascular Treatment of Pulmonary Arteriovenous Malformations: How We Do It

Abstract

Pulmonary arteriovenous malformation (PAVM) is a rare disease disproportionally affecting patients with hereditary hemorrhagic telangiectasia and may be associated with other pulmonary or infectious etiologies. Respiratory symptoms are the most common, including dyspnea, hypoxemia, and hemoptysis. Due to the impairment of normal pulmonary filtration function, patients with PAVM are at risk for embolic events, ranging from ischemic strokes to brain abscesses. More importantly, PAVM can enlarge over time or with physiological changes, which may lead to catastrophic hemorrhages and increased embolization risks. From imaging perspective, echocardiography with contrast bubbles and computed tomography can both be used to diagnose PAVMs with high sensitivity and specificity. Treatment modalities have evolved from invasive surgeries to transluminal catheter-based interventions. In recent decades, the evolution of interventional techniques and equipment has resulted in a high technical success rate for the treatment of PAVMs. Here, we present the interventional PAVM treatment protocol at our institution.

Fístula arterio-venosa pulmonar. Visión de un radiólogo intervencionista

“…Consisten en conexiones anómalas entre arteria y vena pulmonares, obviando de esta manera el lecho capilar y estableciendo un circuito hemodinámico derechaizquierda, siendo este el principal factor desencadenante de las posibles repercusiones clínicas que se derivan en estos pacientes, tales como hipoxemia sistémica que puede desencadenar en cuadros severos de disnea y hemoptisis amenazante. Asimismo y debido al deterioro funcional del filtro pulmonar, existe un incremento en el riesgo de padecer eventos embólicos que van desde accidentes cerebrovasculares isquémicos hasta la formación de abscesos cerebrales 1 . Con el importante desarrollo de las técnicas de imagen, fundamentalmente la era del "angioTC", se han obtenido datos de mayor veracidad acerca de la prevalencia, siendo una enfermedad poco frecuente, estimando algunos estudios su incidencia en 38 casos por 100.000 habitantes 2 .…”

Feasibility of Breath-Hold Zero TE Magnetic Resonance Imaging Sequence for Evaluation of Pulmonary Arteriovenous Malformations After Embolotherapy

“…Technical success rate of embolization is high, and nearly 65% of PAVMs showed complete disappearance. 2 However, retreatment was required for up to 25% of initially successful treatments.…”

“…For occlusion of the feeding artery, detachable or pushable coils or detachable plugs are typically used. Technical success rate of embolization is high, and nearly 65% of PAVMs showed complete disappearance 2 . However, retreatment was required for up to 25% of initially successful treatments.…”