Reperfusion of Pulmonary Arteriovenous Malformations after Successful Embolotherapy with Vascular Plugs

Department of Radiology, University of California, San Francisco, 505 Parnassus Ave, Rm M-361, San Francisco, CA 94143, USA. <>
Journal of vascular and interventional radiology: JVIR (Impact Factor: 2.41). 08/2008; 19(8):1246-50. DOI: 10.1016/j.jvir.2008.05.001
Source: PubMed


Amplatzer vascular plugs (AVPs) are among the embolic agents currently used for occlusion of pulmonary arteriovenous malformations (PAVMs). The authors encountered a patient with multiple PAVMs who developed spontaneous reperfusion of two PAVMs within 7 weeks of initially successful embolization with AVPs. Reperfused PAVMs were effectively occluded by coils deposited proximal to the vascular plugs. AVPs do not provide consistent long-term occlusion of the PAVMs. Deposition of coils proximal to the AVP may decrease the chance of PAVM reperfusion after the embolization.

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    • "While coils have been commonly used for vessel occlusion, a large number of these devices may be necessary to achieve complete occlusion and to minimize the risk of recanalization. To overcome these limitations , new devices have been developed [4] [5] [6]; however, some of these devices require large delivery sheaths and catheters [7], have complicated delivery systems and do not always achieve a fast and durable vessel occlusion [8] [9] [10]. Here, we introduce a novel endoluminal occlusion system for transcatheter vessel occlusion. "
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    ABSTRACT: Endovascular occlusion of blood vessels is an important part of interventional therapy concepts. Here, we evaluate the feasibility, procedural safety and efficacy of the novel endovascular occlusion system (EOS) in the arterial system in a porcine model. Thirteen devices were deployed in the iliac and femoral arteries (diameter: 4-5 mm) of five adult swine. Post-deployment angiography was performed at 1, 5 and 10 min and 6 h. All devices (n = 13) could be successfully delivered without any complications, such as dissection, perforation or rupture. The devices could be easily advanced to the target vessel segment, deployed at the intended target location and produced immediate and complete vessel occlusion which was confirmed to be maintained after 6 h. No leaks, recanalization or device migration was observed. In this pilot study, we demonstrate the feasibility, safety and efficacy of immediate vessel occlusion with the EOS device in the peripheral arterial system in a porcine animal model. Our data indicate that this novel device allows precise delivery without the occurrence of cardiovascular complications. Owing to its long-term safety and efficacy the EOS may represent a promising and effective alternative to currently available devices for vessel occlusion during vascular interventions.
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    ABSTRACT: Three patients who presented with massive hemoptysis after the insertion of a Swan-Ganz catheter for cardiac surgery are reported. Pulmonary artery pseudoaneurysms were diagnosed and successfully treated by embolization with a vascular plug. Follow-up at 15 months showed no recurrence of hemoptysis, and computed tomography helped confirm complete occlusion of the pseudoaneurysms.
    Journal of vascular and interventional radiology: JVIR 03/2010; 21(4):577-81. DOI:10.1016/j.jvir.2009.12.399 · 2.41 Impact Factor
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    ABSTRACT: To evaluate the safety and effectiveness of Amplatzer vascular plugs (AVPs) for percutaneous closure of arteries feeding pulmonary arteriovenous malformations (PAVMs). Over a 45-month period, 24 consecutive patients with at least one PAVM treated with an AVP were selected from a database on patients with a PAVM who received embolotherapy. Immediate technical success was defined as the complete absence of flow through the PAVM after embolization without the need for additional embolization material. Success on follow-up imaging was defined as a reduction in size of at least 70% of the aneurysm or draining vein on follow-up computed tomography or the absence of flow through the PAVM on a subsequent pulmonary angiogram. Thirty-seven AVPs were used to close 36 feeding arteries in 35 PAVMs in seven male and 17 female patients aged 11-86 years (mean age, 50 y). Technical success was achieved in 35 feeding arteries (97%). One feeding artery required two AVPs for closure. There were no immediate procedure-related complications. At a mean clinical follow-up of 322 days (range, 1-1,126 d), all patients were alive without new PAVM-related complications. Imaging follow-up was available for 29 embolized vessels (81%) with a mean follow-up of 418 days (range, 40-937 d), and recanalization occurred in two treated vessels (7%). AVPs are safe and effective for closure of PAVMs feeding vessels that can be reached with a guiding catheter, with an acceptable rate of recanalization.
    Journal of vascular and interventional radiology: JVIR 03/2010; 21(5):649-56. DOI:10.1016/j.jvir.2010.01.026 · 2.41 Impact Factor
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