Long-Term Single-Center Retrospective Follow-Up After Embolization of Pulmonary Arteriovenous Malformations Treated Over a 20-year Period: Frequency of Re-canalization with Various Embolization Materials and Clinical Outcome

Abstract

Purpose. The present study is a register-based observational study of an unselected consecutive patient cohort with pulmonary arteriovenous malformations (PAVMs) from a single national Hereditary Hemorrhagic Telangiectasia and PAVM embolization center. The aim was to investigate the frequency of re-embolizations and the clinical outcome after embolization with use of different embolization materials. Further, to define which PAVM morphology and size of feeding arteries that most often were re-embolized, and to estimate the clinical outcome of the patients including those that were re-embolized. Methods. The population was included from 1996 until 2016 and made a total of 136 patients with 322 PAVMs.. Median follow-up was 38.3 (0.3-241 months). Results. The re-embolization rate was 9.3%. None of the PAVMs treated with detachable silicone balloons were reembolized, while 4.5% treated with vascular plugs and 11.7% treated with coils were re-embolized (p=0.07). In total, 16/74 complex PAVMs were re-embolizedcompared with and 14/248 simple PAVMs, In big sized feeding arteries ≥ 6mm 16/112 were re-embolized compared with 14/210 with smaller sized feeding arteries. 23/30of the re-embolized PAVMs resulted in a successful clinical outcome. Conclusions. Our results suggest that standard coils probably should not be the first choice for embolization of PAVMs and vascular plug alone or in combination with coils might be a better primary option for embolization in these patients.

Approach to Pulmonary Arteriovenous Malformations: A Comprehensive Update

“…One study found AVPs to be very effective in treatment of 24 large PAVMs with feeding artery diameter ≥8 mm, reporting no persistence, migration, or complications in follow-up [102]. Studies show that vascular plugs are less likely to recanalize compared to coils, and that vascular plug alone or in combination with coils might be a better primary option for PAVM embolization when technically feasible [16,103,104]. A 2012 study achieved high rates of technical success treating complex PAVMs by first performing venous sac embolization with detachable coils, followed by occlusion of the large feeding arteries using AVPs [105].…”

Packing density and long-term occlusion after transcatheter vessel embolization with soft, bare-platinum detachable coils

“…For PAVMS treated with baremetal or fibered coils, long-term recanalization rates range from 11.7% to 49%. [16][17][18] As described in these papers, recanalization with fibered coils can be higher in these distal, high flow, and high pressure systems.…”

Treatment of a rare recurrent pulmonary arteriovenous malformation after multiple embolization by robotic-assisted thoracoscopic surgery

“…According to the literature, the incidence of recanalization or collateral circulation in patients with PAVMs after embolization is up to 20% because of the presence of unrecognized additional feeding arteries in the intervention [ 1 ]. Nevertheless, repetitive interventions may increase the incidence of embolization complications such as vascular recanalization, establishment of collateral circulation and down-stream migration of the device [ 2 ]. And some researchers believe that patients with repeated imaging procedures and therapeutic interventions can result in levels of radiation exposure that would be classified as harmful [ 3 , 4 ].…”