Occlusion Time for Amplatzer Vascular Plug in the Management of Pulmonary Arteriovenous Malformations

Aal, Ahmed Kamel Abdel; Hamed, Maysoon F.; Biosca, Roderick; Saddekni, Souheil; Raghuram, Karthikram

doi:10.2214/ajr.08.1534

Cited by 48 publications

(21 citation statements)

References 24 publications

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“…Due to the theoretical increased thrombogenic effect of AVP 2 compared with AVP, our hypothesis was that AVP 2 could have a shorter OT compared with AVP. The average OT for the AVP in our study was 3 min 54 s, which was in line with the published literature (8). The average OT for the AVP 2 was 5 min 30 s, which was unexpectedly longer than that of AVP.…”

Section: Discussionsupporting

confidence: 92%

“…Successful use of AVP and AVP 2 for embolotherapy of PAVMs has been reported in several studies (8,(12)(13)(14)(15)(16)(17). Compared with the AVP device, the AVP 2 has multiple layers of finer, more densely woven nitinol mesh and a multisegmented design, which theoretically increases its thrombogenic effect and decreases the OT (9).…”

Section: Discussionmentioning

confidence: 99%

“…Compared with the AVP device, the AVP 2 has multiple layers of finer, more densely woven nitinol mesh and a multisegmented design, which theoretically increases its thrombogenic effect and decreases the OT (9). 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 a higher risk of systemic paradoxical embolization (8). However, to our knowledge, there are no studies published in the literature regarding the OT of AVP 2 used in the treatment of PAVMs.…”

Section: Discussionmentioning

confidence: 99%

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

Elantably²

2017

Diagn Interv Radiol

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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...

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Elantably²

2017

Diagn Interv Radiol

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“…Persistence can result from recanalization of the occluded vessels through the previously placed embolic material; interval reperfusion through accessory vessels from the pulmonary or systemic circulation; or incomplete primary treatment, especially in complex PAVMs (2,(8)(9)(10). Recanalization of the occluded feeding artery is considered as the most common cause of persistence of PAVM treated with coils, occurring in 88%-91% of these patients (1,(10)(11)(12).…”

Section: Discussionmentioning

confidence: 99%

Persistence of pulmonary arteriovenous malformations after successful embolotherapy with Amplatzer vascular plug: long-term results

Aal¹,

Ibrahim²,

Moustafa³

et al. 2016

Diagn Interv Radiol

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“…7 Os sinais e sintomas mais comuns são fadiga, dispneia de esforço, palpitações, cianose e hemoptise, sendo a dispneia o mais frequente. 8 Complicações graves como abscesso cerebral, acidente vascular encefálico ou acidentes isquêmicos cerebrais transitórios, como os apresentados por essa paciente, são relatados.…”

Section: Discussionunclassified

Oclusão de fístula arteriovenosa pulmonar com plug vascular em paciente com embolia cerebral paradoxal prévia

Faria¹,

Garzon²,

Jacob³

2011

Rev. Bras. Cardiol. Invasiva

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Fístula arteriovenosa pulmonar (FAVP), uma rara anormalidade vascular, é uma comunicação direta entre a artéria e a veia, sem a interposição do leito capilar, representando shunt extracardíaco direito-esquerdo.1 Quando significativa, pode causar sinais e sintomas clínicos, tais como fadiga fácil, dispneia de esforço, cianose, hemoptise e complicações importantes como abscesso cerebral, ataque isquêmico transitório e acidente vascular encefálico. 2Neste artigo, descrevemos o caso de uma paciente com FAVP que apresentou dois episódios de acidente isquêmico transitório (AIT) prévios, sendo submetida a oclusão percutânea do defeito com Amplatzer TM ABSTRACT Occlusion of Pulmonary Arteriovenous Fistula Using Vascular Plug in a Patient with Previous Paradoxal Cerebral EmbolismPercutaneous transcatheter embolization has become the treatment of choice for pulmonary arteriovenous fistulae (PAVFs), replacing surgical intervention in most cases. Classical devices, such as intravascular coils and detachable balloons, have proven to be successful for percutaneous occlusions of small or medium-sized PAVFs; however, they are not ideal for larger and high flow fistulae due to the risk of embolization to systemic circulation. The case of a 49-year-old woman with high flow pulmonary fistula and previous neurological ischemic manifestations undergoing successful transcatheter closure with an Amplatzer TM Vascular Plug II, a device designed for occlusion of vascular abnormalities, is reported. KEY-WORDS:Arteriovenous fistula. Pulmonary artery. Embolization, therapeutic. Coronary occlusion. RESUMOA embolização percutânea transcateter tornou-se o tratamento de escolha para fístulas arteriovenosas pulmonares (FAVPs), na maioria dos casos em substituição à intervenção cirúr-gica. Os dispositivos clássicos, tais como coils intravasculares e balões destacáveis, provaram ser um sucesso para oclusões percutâneas de FAVPs pequenas ou médias; porém, não são ideais nas fístulas maiores e de alto fluxo pelo risco de embolização para a circulação sistêmica. Relatamos o caso de uma mulher de 49 anos de idade com FAVP de alto fluxo e manifestações neurológicas isquêmicas prévias, submetida com sucesso a fechamento percutâneo com Amplatzer RELATO DO CASOPaciente do sexo feminino, com 49 anos de idade, apresentou quadro de paresia e parestesia em membro superior direito há três anos, que regrediu em 24 horas, sendo atendida em outro serviço em que foi confirmado diagnóstico de AIT por meio de ressonân-cia nuclear magnética. Ainda nesse atendimento foi realizada radiografia de tórax, evidenciando duas imagens nodulares com densidade de partes moles e limites precisos (> 8 mm) em base pulmonar esquerda. O mesmo quadro clínico se repetiu três meses depois. Em decorrência do aspecto radiológico confirmado nesse segundo episódio de AIT, a paciente foi avaliada por pneumologista, que levantou a hipótese diagnóstica de malformação arteriovenosa pulmonar, sendo encaminhada para o serviço de cirurgia vascular. Após período longo de avaliação e medicação co...

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Occlusion Time for Amplatzer Vascular Plug in the Management of Pulmonary Arteriovenous Malformations

Cited by 48 publications

References 24 publications

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

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

Persistence of pulmonary arteriovenous malformations after successful embolotherapy with Amplatzer vascular plug: long-term results

Oclusão de fístula arteriovenosa pulmonar com plug vascular em paciente com embolia cerebral paradoxal prévia

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