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: 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.
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