Reperfusion of Pulmonary Arteriovenous Malformations after Successful Embolotherapy with Vascular Plugs

ArticleinJournal of vascular and interventional radiology: JVIR 19(8):1246-50 · August 2008with8 Reads
DOI: 10.1016/j.jvir.2008.05.001 · Source: PubMed
Abstract
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.
    • "In the literatures, recanalization after successful embolization has been the main cause for reperfusion of PAVMs (Pollak et al. 2006; Milic et al. 2005). The reported recanalization rates were up to 20% of PAVMs treated with coils (Pollak et al. 2006; Milic et al. 2005) and 5 to 10% of PAVMs treated with AVPs (Trerotola & Pyeritz 2010; Fidelman et al. 2008 ), possibly through the coil interstices or plug meshes. The technical reason for recanalization may be inadequate cross-sectional occlusion with a fewer number of devices or those of inappropriate size than desired (Milic et al. 2005). "
    [Show abstract] [Hide abstract] ABSTRACT: The purpose of this study is to describe our initial experience with embolization of pulmonary arteriovenous malformations (PAVMs) using hydrogel microcoils. The technical and radiological outcomes were retrospectively reviewed in seven patients with nine simple-type PAVMs (median feeder size 4 mm, range 3-6 mm) who underwent embolization. Hydrogel microcoils were mainly used, and detachable bare microcoils were combined as needed to occlude the terminal feeding artery just before the sac. Of a total of 43 microcoils, 30 (69.8%) hydrogel microcoils were deployed in eight PAVMs with the median number 3.5 (range 2 to 6) per lesion. All hydrogel microcoils were successfully deployed without microcatheter stuck or malposition. In the remaining one small PAVM, only soft bare microcoils were used, however, resulting in recanalization requiring additional coils in the second session. The venous sac was substantially shrunk in all lesions treated with hydrogel microcoils with the median size reduction rate 95.0% (range 81.8% to 99.0%) during the median follow-up period 10 months (range 6 to 18 months). In conclusion, hydrogel microcoils were safely and effectively applied for occluding PAVMs with relatively small feeders.
    Full-text · Article · Oct 2014
    • "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 developed456; 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 occlusion8910. Here, we introduce a novel endoluminal occlusion system for transcatheter vessel occlusion. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Jul 2013
    • "In this case, the patient's anatomy and the technique used appeared to be the major contributors to occlusion failure. Other reports of recanalization have been related to embolization of PAVMs, with a total of 4 cases reported202122. Despite these failures, AVP seems to be very effective in treating PAVM. In a series of 30 patients with 39 feeder vessels, Trerotola et al. [23] used a combination of AVP and adjunct coils; over an average follow-up of 13 months, there was no evidence of recanalization. "
    [Show abstract] [Hide abstract] ABSTRACT: The Amplatzer Vascular Plug (AVP) is an established embolic device that can be an excellent alternative to coils or detachable balloons to embolize medium to large vessels with high flow. The device is easy to use and can be precisely deployed in the target vessel with high resistance to migration and a low recanalization rate. The technical success of this device is high, indications for use are expanding, and no absolute contraindications have been reported. Since its introduction, the AVP has grown from a single device to a group of 4 models (AVP, AVP II, AVP III, and AVP 4). Each model has a unique design and features that fit different vascular anatomies, hemodynamic situations, and clinical scenarios. Therefore, the new models cannot simply be treated as replacements for older ones. Unpredictable occlusion time remains a major shortcoming for the new models of the AVP. Large vessel size, high flow status, and coagulopathy can prolong the occlusion time, which can offset the cost benefit, reduced procedure time, and reduced radiation dose typically seen with use of the AVP alone. Coils or multiple AVPs can be used to expedite the occlusion process, and large Gelfoam particles also can be used as an adjunct to achieve rapid and reliable occlusion with minimal cost.
    Full-text · Article · Apr 2012
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