Pulmonary Arteriovenous Malformations Treated with Embolotherapy: Helical CT Evaluation of Long-term Effectiveness after 2–21-Year Follow-up

Abstract

Long-term CT follow-up of initially successfully treated PAVMs revealed successful embolotherapy of 75% and partially or completely failed embolotherapy of 25% of PAVMs.

Screening for pulmonary arteriovenous malformations using transthoracic contrast echocardiography: a prospective study

“…The PAVM prevalence differs between these two subtypes, in HHT type 1 the prevalence is 48%, whereas the prevalence in HHT type 2 is 5% [10]. PAVMs can be effectively treated with transcatheter embolotherapy, which has proven safe and effective in long-term studies [11][12][13][14][15][16][17][18]. Recently, it has been proven that embolisation of PAVMs is effective in the prevention of brain abscess and ischaemic stroke if complete occlusion of all PAVMs is achieved [5].…”

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

“…According to the criteria published by Remy-Jardin et al (22), which are based on the morphologic changes and the perfusion findings in the PAVMs on CTA, successful treatment was encountered in 34 PAVMs (97%). This was evident by complete disappearance of the aneurysmal sac in 22 of the 34 PAVMs (65%), and a decrease in size of aneurysm sac of >30% (range, 54%-84%) in the remaining 12 PAVMs (35%) (Fig.…”

“…Analysis of the CTA images was based on the categories published by Remy-Jardin et al (22), which were based on morphologic changes and the perfusion of PAVMs on CTA; (a) successful treatment: marked (>30%) reduction or disappearance of the aneurysmal sac, with no pulmonary or systemic perfusion; (b) partially successful treatment: ≤30% reduction in the size of the aneurysmal sac, with patent feeding artery(ies) distal to the embolic device that is smaller than 3 mm in diameter, which is too small to require repeat intervention; (c) partially failed treatment: substantial reduction in the size of the aneurysmal sac, with patent feeding artery(ies) distal to the embolic device that is larger than 3 mm in diameter, which was large enough to justify repeat intervention; and (d) failed treatment: unchanged or enlarged aneurysmal sac with persistent perfusion. Any case that showed subsequent development of additional feeding artery or development of systemic perfusion supplying the aneurysm was considered as failed treatment.…”

Pulmonary Arterio-Venous Malformation (PVAM) Presenting as Recurrent Hemoptysis

“…Therefore, longterm follow up, including chest CT examinations every 1 to2 years, is recommended. [17] Surgery: Surgery remained the treatment of choice until the 1980s but was never the ideal solution for the multiple PAVMs of HHT; more recently, however, surgery has been a useful adjunctive therapy for selected cases. It is used in cases where PAVMs are single or sufficiently localized for thoracoscopic resection and when embolization is not feasible.…”