Abstract
Objectives: Pulmonary arteriovenous malformations (PAVMs) are structurally abnormal vessels that provide direct capillary-free communication between the pulmonary and the systemic circulations and hence an anatomic right to left shunt. They are commonly caused by hereditary hemorrhagic telangiectasia (HHT). Treating these lesions is of high clinical priority as they can increase the incidence of developing stroke and cerebral abscesses. The main indication to treat these lesions is when the feeding artery measures more than 4 cm. Here, we present our experience in treating 18 patients with endovascular embolization in Nottingham University Hospitals. Methods: A retrospective review of all the PAVMs underwent endovascular embolization between October 2014 and November 2019 (5 years) was conducted. We reviewed the number of treatments, clinical success, complications, and the recanalization rates. Results: A total of 18 patients with PAVMs treated with endovascular embolization over 5 years. There were 12 males and 6 females with mean age of 56 years. The documented and genetically proven underlying cause was found to be HHT in most cases (15 patients). A total of 25 treatments were performed (4 patients had multiple AVMs treated in separate occasions and two patients had recanalization of previously treated AVMs which were then re-treated). One patient with AVM underwent angiogram which showed multiple small AVMs which were not treated. One patient had difficult embolization with migration of coil into the pulmonary vein and the right ventricle which was then retrieved using a vascular snare with resolution of ectopics and no late complications developed. No major or minor postembolization complications developed; one patient was admitted postembolization with pleuritic pain which was treated conservatively. No patients suffered a stroke or cerebral abscess since treatment. Sixteen treatments had documented successful improvement in their oxygen saturations on respiratory review. Three patients developed recanalization (defined as persistent perfusion through a previously placed coil). Two patients had further treatments and one patient did not have further treatment. Conclusion: Endovascular embolization is a minimally invasive treatment for PAVMs with high technical and clinical success and low complication rate. The most common persistent pattern in our series was found to be recanalization. Publication Date: 26 April 2021 (online) © 2020. The Arab Journal of Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/). Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India