Embolotherapy of pulmonary arteriovenous malformations: long-term results in 112 patients

Abstract

Purpose: To evaluate the long-term results of embolotherapy of pulmonary arteriovenous malformations (PAVMs) in a large group of patients.

Materials and methods: Between July 1988 and August 2001, 134 consecutive patients underwent embolotherapy of PAVMs with feeding arteries larger than 3 mm or that had previously caused bleeding or systemic complications. The mean follow-up was 62.2 months. The primary endpoints of the study were the efficacy of embolotherapy, decrease in right-to-left shunt, and increase in partial arterial oxygen pressure (PaO(2)); the secondary endpoint was the prevalence of complications. Standard follow-up consisted of yearly history, chest radiography, and arterial blood gas measurement.

Results: Follow-up was available in 112 patients. Initially, 296 PAVMs were embolized in these patients. Nineteen patients (17%) underwent a second procedure and four patients underwent a third procedure because of recanalization of originally occluded feeding arteries (25 PAVMs, 8%) or interval enlargement of untreated PAVMs (53 PAVMs). In total, 349 PAVMs were embolized in 157 sessions. The mean diameter of occluded vessels was 4.7 mm. The long-term outcomes of embolotherapy were successful in 83% of patients overall and in 96% of patients in whom all angiographically visible PAVMs were embolized. Recanalization occurred in 12 of 16 patients who underwent repeat treatment because of enlargement of nonembolized PAVMs. Postprocedural pleurisy occurred after 14 of 157 sessions (9%). Periprocedural complications occurred in 12 sessions (8%) and included migration of an embolic device, transient ischemic attack (TIA), angina pectoris, and early cerebral infarction after embolization. Three patients experienced TIA and two patients experienced a cerebral abscess during follow-up after embolotherapy.

Conclusions: Embolotherapy of PAVMs is efficacious and durable in the majority of patients. Patients should remain under regular review because recanalization of PAVMs or enlargement of untreated PAVMs can occur years after treatment.