Abstract 500: Treatment of Arterial Embolization for Pulmonary Arteriovenous Malformations With and Without Osler Disease

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Yasutaka Kawamura ◽  
Motoji Fukazawa ◽  
Shinya Hasegawa ◽  
Yukio Chiba
Keyword(s):  
Arteriovenous Malformations ◽  
Arterial Embolization ◽  
Additional Treatment ◽  
Lung Damage ◽  
Normal Lung ◽  
Pulmonary Arteriovenous Malformations ◽  
Embolization Therapy ◽  
3 Dimensional ◽  
Distal Side ◽  
Pulmonary Arterial

Purpose: We report cases with pulmonary arteriovenous malformations (PAVM) treated with transcatheter arterial embolization. The clinical features of PAVM and the indication, techniques and longterm outcome of the embolization therapy were assessed. Patients: Six patients (age ranges from 44 to 67, five women and a man) had diagnosed as PAVM. Two patients diagnosed as definite HHT: Hereditary Hemorrhagic Telangiectasia (Rendu-Osler-Weber Syndrome) with epistaxis and family history and one as possible HHT associating hemorrhagic skin telangiectasias and abnormally enlarged the internal thoracic artery. Indication of the pulmonary arterial embolization therapy: Four patients had the episodes of cerebral infarction, one developed cerebellar ataxia, and another patient was proved the decreased PaO 2 . Two patients revealed the enlargement of PAVM. CT and 3-dimensional CT angiography (CTA) was obtained on 64-multi-detector row unit (Toshiba, Aquilion64, Japan) with bolus injection of contrast agent. The transcatheter pulmonary arterial embolization was performed with microcatheter system (TERUMO, Japan) and 0.035 coils of 6, 4, 3mm in diameter (Boston Scientific, USA). Results: After the selective catheterization for PAVM, all feeding arteries >3 mm in diameter was embolized. Since coil size selection was crucial for the safe and productive procedure, the size of feeding arteries had been carefully estimated on CTA date in advance. All patients were successfully treated without any problems during and after the procedure. One patient with HHT, three years after the treatment of 4.3cm PAVM, showed the recurrent PAVM of 0.5mm in diamete. The other patient showed a small vessel emerged distal to the embolized PAVM draining to the pulmonary vein. These lesions were too small to consider the clinical management and had been followed up with no change. Conclusion: The pulmonary arterial embolization therapy for PAVM was discussed. The treatments were successful, however, some recurrences were noted. We did not thoroughly embolized the distal side of PAVM because to minimize the normal lung damage and to avoid the migration of coils. Deliberate clinical follow-up should be required and should apply the additional treatment, if necessary.

scholarly journals Safety of Catheter Embolization of Pulmonary Arteriovenous Malformations—Evaluation of Possible Cerebrovascular Embolism after Catheter Embolization of Pulmonary Arteriovenous Malformations in Patients with Hereditary Hemorrhagic Telangiectasia/Osler Disease by Pre- and Post-Interventional DWI

2021 ◽  
Vol 10 (4) ◽  
pp. 887
Author(s):  
Guenther Schneider ◽  
Alexander Massmann ◽  
Peter Fries ◽  
Felix Frenzel ◽  
Arno Buecker ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Pulmonary Arteriovenous Malformations ◽  
B Values ◽  
Safe Method ◽  
Embolization Therapy ◽  
Catheter Embolization ◽  
Contrast Enhanced ◽  
Previously Treated ◽  
The Brain ◽  
Over Time

Background. This paper aimed to prospectively evaluate the safety of embolization therapy of pulmonary arteriovenous malformations (PAVMs) for the detection of cerebral infarctions by pre- and post-interventional MRI. Method One hundred and five patients (male/female = 44/61; mean age 48.6+/−15.8; range 5–86) with pre-diagnosed PAVMs on contrast-enhanced MRA underwent embolization therapy. The number of PAVMs treated in each patient ranged from 1–8 PAVMs. Depending on the size and localization of the feeding arteries, either Nester-Coils or Amplatzer vascular plugs were used for embolization therapy. cMRI was performed immediately before, and at the 4 h and 3-month post-embolization therapy. Detection of peri-interventional cerebral emboli was performed via T2w and DWI sequences using three different b-values, with calculation of ADC maps. Results Embolization did not show any post-/peri-interventional, newly developed ischemic lesions in the brain. Only one patient who underwent re-embolization and was previously treated with tungsten coils that corroded over time showed newly developed, small, diffuse emboli in the post-interventional DWI sequence. This patient already had several episodes of brain emboli before re-treatment due to the corroded coils, and during treatment, when passing the corroded coils, experienced additional small, clinically inconspicuous brain emboli. However, this complication was anticipated but accepted, since the vessel had to be occluded distally. Conclusion Catheter-based embolization of PAVMs is a safe method for treatment and does not result in clinically inconspicuous cerebral ischemia, which was not demonstrated previously.

The role of angiogenesis in the development of pulmonary arteriovenous malformations in children after cavopulmonary anastomosis

1997 ◽  
Vol 7 (4) ◽  
pp. 370-374 ◽  
Author(s):  
Blair Marshall ◽  
Brian W. Duncan ◽  
Richard A. Jonas
Keyword(s):  
Arteriovenous Malformations ◽  
Fontan Procedure ◽  
Pulmonary Arteriovenous Malformations ◽  
Arterial Circulation ◽  
Clinical Observations ◽  
Bidirectional Glenn Shunt ◽  
Cavopulmonary Anastomosis ◽  
Pulmonary Arterial ◽  
End Stage

AbstractPulmonary arteriovenous malformations are a frequent cause of progressive cyanosis after construction of a cavopulmonary anastomosis. Their formation complicates the management of children with single ventricle physiology after a bidirectional Glenn shunt or the Kawashima procedure. The key role of the liver in this phenomenon is suggested by the observation that providing modifications of the Fontan procedure which permit hepatic venous effluent to reach the pulmonary arterial circulation limit further development of the malformations. In addition, it is known that patients with end-stage hepatic failure develop pulmonary arteriovenous malformations that diminish after liver transplantation. We have begun purification of a factor derived from hepatocyte-conditioned media that is inhibitory for the proliferation of cultured endothelial cells. This substance is heat sensitive, and binds avidly to a copper-containing chromatography column. These clinical observations, and this preliminary experimental work, support the concept that hepatic-derived angiogenic factors may play a role in the development of pulmonary arteriovenous malformations after construction of cavopulmonary anastomoses.

scholarly journals Where is the Origin of the Last Normal Branch from Feeding Artery of Pulmonary Arteriovenous Malformations?

2018 ◽  
Vol 41 (12) ◽  
pp. 1849-1856
Author(s):  
Miyuki Maruno ◽  
Hiro Kiyosue ◽  
Norio Hongo ◽  
Shunro Matsumoto ◽  
Hiromu Mori
Keyword(s):  
Arteriovenous Malformations ◽  
High Flow ◽  
Pulmonary Arteriovenous Malformations ◽  
Feeding Artery ◽  
Special Interests ◽  
Level Of Evidence ◽  
Pulmonary Arteriography ◽  
Normal Branch ◽  
Level 3 ◽  
Pulmonary Arterial

Abstract Purpose Reperfusion via pulmonary-to-pulmonary arterial anastomoses is known as one type of recurrence of pulmonary arteriovenous malformations (PAVMs) after embolization. It is important to occlude the fistulous portion beyond the origin of the last normal branch from feeding artery of PAVMs to prevent recurrence. In this study, we evaluate the origin of the last normal branch by CT as well as its visibility on pulmonary arteriography (PAG). Materials and Methods We reviewed forty patients with 77 PAVMs who underwent coil embolization between October 2007 and December 2017. All patients underwent MDCT before embolization. Axial and MPR CT lung images were reviewed with special interests in the origin of the last normal branch from feeding artery of PAVMs. The origin was classified into three portions, including sac, junction (portion just proximal to the sac) and proximal feeder (more than 5 mm proximal to the sac). We also evaluated whether PAG can depict the normal branches detected by MDCT. Results MDCT showed that the last normal branch originated from sac in 30 PAVMs (39.0%), junction in 39 (50.6%), and proximal feeder in 8 (10.4%).On selective PAG, the last normal branch could be visualized in 30 PAVMs (39.0%), although it could not be visualized due to high-flow shunt in the other 47 PAVMs. Conclusions Selective PAG frequently fails to demonstrate the last normal branch from feeding artery of PAVMs, which often originates from the sac. Pretherapeutic evaluation of CT images of the last normal branch is important to prevent reperfusion of PAVMs. Level of Evidence Level 3, local non-random sample.

scholarly journals Massive Pulmonary Hemorrhage from Dual Circulation Pulmonary Arteriovenous Malformations in Hereditary Hemorrhagic Telangiectasia

2004 ◽  
Vol 11 (8) ◽  
pp. 597-598 ◽  
Author(s):  
Krishna B Sharma ◽  
Lutz Forkert
Keyword(s):  
Young Woman ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Arteriovenous Malformations ◽  
Pulmonary Hemorrhage ◽  
Arterial System ◽  
Massive Hemoptysis ◽  
Pulmonary Arteriovenous Malformations ◽  
Uncommon Presentation ◽  
Life Threatening ◽  
Pulmonary Arterial

Pulmonary arteriovenous malformations (AVMs) are commonly supplied by the pulmonary arterial system and rarely by the systemic bronchial circulation. The authors outline the case of a young woman with pulmonary AVMs as part of hereditary hemorrhagic telangiectasia with the uncommon presentation of massive hemoptysis. Management of her recurrent, life-threatening pulmonary hemorrhage was complicated by pulmonary AVMs that were supplied by both the pulmonary and systemic bronchial arterial circulatory systems. Transcatheter embolotherapy of the higher pressure bronchial systemic circuit was necessary for acute hemostasis.

scholarly journals Contemporary Management of Pulmonary Arteriovenous Malformations

2017 ◽  
Vol 26 (04) ◽  
pp. 205-211 ◽  
Author(s):  
Nicholas Rauh ◽  
John Gurley ◽  
Sibu Saha
Keyword(s):  
Arteriovenous Malformations ◽  
Transcatheter Embolization ◽  
Diagnostic Methods ◽  
Pulmonary Arteriovenous Malformations ◽  
Operative Techniques ◽  
University Of Kentucky ◽  
Vascular Structures ◽  
Pulmonary Arterial ◽  
Contemporary Management ◽  
The University

AbstractPulmonary arteriovenous malformations (PAVMs) are atypical vascular structures involving a direct connection between the pulmonary arterial and venous circulations. While PAVMs are a relatively uncommon disorder, unmanaged cases are at risk for the development of serious complications including embolization and infection. Since their first description in 1897, PAVMs have been identified and treated in a variety of ways. Advancements in diagnostic methods and operative techniques have allowed for more effective treatment of the disease. Most recently, the use of vascular plug transcatheter embolization has been described as an effective therapeutic procedure in the management of PAVMs. In this report, we present our experience with nine cases of PAVMs treated at the University of Kentucky, including special consideration of an exemplary case that illustrates the typical course of treatment for the disease.

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