J Korean Soc Radiol.  2010 Dec;63(6):495-503.

Pulmonary Arteriovenous Malformation in the Korean Population: Clinical Manifestations and the Long-Term Results of Transarterial Embolotherapy

• Lee JA
• Kwak HS
• Jin GY
• Han YM
• Roh BS

Abstract

PURPOSE
This study was designed to evaluate the general features and the long-term results of transarterial embolotherapy (TAE) for the treatment of pulmonary arteriovenous malformations (PAVMs).
MATERIALS AND METHODS
Thirteen (n=13) patients who underwent TAE for PAVMs were identified. These patients were comprised of 4 men and 9 women, aged between 19 and 67 years (mean age, 44 years). The authors evaluated the general features of PAVMs, including, type, location, size, and symptoms. In addition, results following TAE were analyzed to evaluate its efficacy, and to investigate arterial oxygen pressure changes.
RESULTS
In total, 13 patients presented with 21 angiographically confirmed PAVMs. Nine (69.2%) patients had single PAVM. Of the 21 PAVMs, 19 were simple, 16 were located in lower lobes, and 17 were located in the subpleural region. Furthermore, 2 of the 13 patients experienced coughing, 2 experienced dyspnea, and 1 experienced massive hemoptysis. All PAVMs were subjected to superselective TAE using a detachable balloon or coils. Six PAVMs (28.6%) in three patients (23.1%) were subsequently recanalized as determined by contrast-enhanced CT scan. All 3 patients were identified during long-term follow up (mean: 61.9 months). One of the 3 patients experienced an acute stroke due to thrombi migration in the middle cerebral artery following PAVM recanalization.
CONCLUSION
TAE with coils is effective for the treatment of PAVMs, and it should be noted that patients who undergo embolotherapy require careful surveillance, due to the need for recanalization during follow-up.

MeSH Terms

Aged
Arteriovenous Malformations
Cough
Dyspnea
Embolization, Therapeutic
Female
Follow-Up Studies
Hemoptysis
Humans
Male
Middle Cerebral Artery
Oxygen
Pulmonary Artery
Stroke
Oxygen

Figure

• 

  Fig. 1 A 19-year-old woman with 4 incidentally found PAVMs. A-D. A superselective angiogram through a 3-F microcatheter shows four PAVMs (arrows) in both lungs (A; 19-mm size, complex type, B; 15-mm size, simple type, C; 5-mm size, simple type, D; 3-mm size, simple type). E, F. No residual filling of these four PAVMs are observed by final angiography after coil placement. G. Chest radiograph obtained ten years after embolization shows elongated and loosened coils (arrows). H. Pulmonary angiogram obtained after repeat embolization of the 4r PAVMs shows complete obliteration of the feeding arteries (white arrows - complex type, black arrows - simple type).

• 

  Fig. 2 A 55-year-old man with a mass-like PAVM. A. Initial CT scan shows a mass-like PAVM in the right lower lobe. The detachable balloon has deflated in the feeding artery. B. He is admitted to the emergency room due to acute stroke 168-months post-embolization. Cerebral angiogram shows the presence of an acute thrombus in the right middle cerebral artery. C. A maximum intensity projection image of CT performed after admission shows the draining vein after recanalization (arrow). D. A contrast-enhanced CT scan shows a thrombus-filled nidus in the previous-embolized PAVM (arrows).

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