Tuberc Respir Dis.  2009 Jul;67(1):52-58.

Transcatheter Embolotherapy of Giant Pulmonary Arteriovenous Malformation Using Amplatzer(R) Vascular Plug

Affiliations
  • 1Department of Internal Medicine, Korea University College of Medicine, Ansan Hospital, Ansan, Korea. chepraxis@korea.ac.kr
  • 2Department of Radiology, Korea University College of Medicine, Ansan Hospital, Ansan, Korea.

Abstract

Pulmonary arteriovenous malformation (PAVM) is a rare pulmonary vascular anomaly due to an abnormal communication between the pulmonary artery and vein. The most common presenting symptom is a dyspnea on exertion related to this right-to-left shunt. If left untreated, PAVM has been known to result in serious complications. Incomplete pulmonary capillary network can be the cause of cerebral abscesses and other non-infectious neurological complications, such as stroke and transient ischemic attacks due to paradoxic embolism Transcatheter embolotherapy, using coils or balloons, has replaced surgical resection as the treatment of choice for PAVM. However, the risk of device embolization has limited the use of coil embolotherapy, while the size of PAVM is huge. Recently, Amplatzer(R) Vascular Plug has been proposed as an alternative endovascular occlusion device for arteriovenous malformation. We report a case of 81-year-old male patient with a giant PAVM, which was successfully treated by transcatheter embolotherapy using the Amplatzer(R) Vascular Plug.

Keyword

Arteriovenous malformations; Pulmonary disease; Therapeutic embolization

MeSH Terms

Aged, 80 and over
Arteriovenous Malformations
Brain Abscess
Capillaries
Dyspnea
Embolism
Embolization, Therapeutic
Humans
Ischemic Attack, Transient
Lung Diseases
Male
Pulmonary Artery
Stroke
Veins

Figure

  • Figure 1 (A) Chest radiograph on admission showed a circumscribed mass shadow in the left lower hemithorax. (B~D) Computed tomography (CT) scan of chest revealed centrilobular emphysema on whole lung fields and a large saccular dilatation of left pulmonary artery directly draining to left pulmonary vein in the left lower lobe.

  • Figure 2 (A) Left pulmonary arteriogram showed large pulmonary arteriovenous malformation. (B, C) A 12 mm Amplatzer® Vascular Plug was inserted and deployed via 7F guiding catheter. (D) Pulmonary arteriovenous malformation was not seen on follow-up arteriogram.

  • Figure 3 The size of previously described mass shadow of pulmonary arteriovenous malformation in the left lower lobe decreased on chest radiograph (A) and chest CT (B~D) after transcatheter embolotherapy with 12 mm Amplatzer® Vascular Plug located at feeding artery of pulmonary arteriovenous malformation.

  • Figure 4 Pulmonary arteriovenous malformation (A, arrowhead) disappeared after embolotherapy with 12 mm Amplatzer® Vascular Plug (B). Amplatzer Vascular Plug was located at feeding artery (arrow) on 3-dimensional CT.


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