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.

scholarly journals Successful treatment of bilateral multiple pulmonary arteriovenous malformations in a patient with brain abscess and severe hypoxemia using a combination of transcatheter embolotherapy and surgical resection: a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Takahiro Ochi ◽  
Masako Chiyo ◽  
Takamasa Ito ◽  
Hideharu Furumoto ◽  
Toshihiko Sugiura ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Brain Abscess ◽  
Surgical Resection ◽  
Arteriovenous Malformations ◽  
Pulmonary Arteriovenous Malformation ◽  
Positive Pressure ◽  
Pulmonary Arteriovenous Malformations ◽  
Severe Hypoxemia ◽  
History Of ◽  
The Brain

Abstract Background A pulmonary arteriovenous malformation is an abnormal dilated blood vessel that makes direct communication between a pulmonary artery and pulmonary vein and can be associated with hypoxemia or neurological complications, including brain abscess and cerebral infarction. Treatment of pulmonary arteriovenous malformation includes surgical resection and transcatheter embolotherapy, however the adaptation of therapies should be considered when a patient is in bad condition. Case presentation A 51-year-old man was admitted after developing fever, consciousness disorder, and hypoxemia. Magnetic resonance imaging of the brain showed a brain abscess. Bilateral pulmonary arteriovenous malformations were found by contrast computed tomography. Because of a family history of pulmonary arteriovenous malformation, a history of epistaxis, and the existence of oral mucosa telangiectasia, he was diagnosed with hereditary hemorrhagic telangiectasia and brain abscess caused by intrapulmonary right-to-left shunt. The brain abscess improved with antibiotic treatment; however, the administration of oxygen did not ameliorate his hypoxemia. His hypoxemia was exacerbated by positive pressure ventilation. Considering his systemic and respiratory condition, we considered surgery to involve a high degree of risk. After controlling his brain abscess and pneumonia, transcatheter embolotherapy was performed. This improved his systemic condition, enabling surgical treatment. Conclusions This middle-aged patient suffering from brain abscess and severe hypoxemia with multiple pulmonary arteriovenous malformations was successfully treated by a combination of transcatheter embolotherapy and surgery. The adaptation and combination of therapies, as well as the sequence of treatments, should be considered depending on the patient status and lesions.

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.

Endovascular Management of Massive Hemoptysis Secondary to Systemic Collaterals in Previously Treated Pulmonary Arteriovenous Malformation

2019 ◽  
Vol 53 (8) ◽  
pp. 674-678
Author(s):  
Ujjwal Gorsi ◽  
Akash Bansal ◽  
Tejeshwar Singh Jugpal ◽  
Sreedhara Bettadahally Chaluvashetty ◽  
Manavjit Singh Sandhu
Keyword(s):  
Case Report ◽  
Pulmonary Artery ◽  
Arteriovenous Malformation ◽  
Arteriovenous Malformations ◽  
Treatment Guidelines ◽  
Massive Hemoptysis ◽  
Pulmonary Arteriovenous Malformations ◽  
Endovascular Management ◽  
Previously Treated ◽  
Thin Walled

Pulmonary arteriovenous malformations (PAVMs) are abnormal connections between pulmonary artery and vein through a thin-walled aneurysmal sac, leading to a right-to-left shunt. These are commonly associated with hereditary hemorrhagic telangiectasia, and treatment guidelines have been set on how to approach their management. Incorrect proximal placement of an embolization device can lead to delayed recruitment of systemic collaterals leading to presentation with hemoptysis. We are presenting a case of a 17-year-old male with treated PAVMs and with fresh hemoptysis. In this case report, we attempt to explain the management of such a complication and follow the principles of arteriovenous malformation embolization on the left side.

Gamma knife surgery for arteriovenous malformations in the brain: integration of time-resolved contrast-enhanced magnetic resonance angiography into dosimetry planning

2007 ◽  
Vol 107 (4) ◽  
pp. 854-859 ◽  
Author(s):  
Christian A. Taschner ◽  
Vianney Le Thuc ◽  
Nicolas Reyns ◽  
Juergen Gieseke ◽  
Jean-Yves Gauvrit ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Mr Angiography ◽  
Data Sets ◽  
Time Resolved ◽  
Contrast Enhanced ◽  
Hybrid Data ◽  
Brain Avms ◽  
The Brain

Object The aim of this study was to develop an algorithm for the integration of time-resolved contrast-enhanced magnetic resonance (MR) angiography into dosimetry planning for Gamma Knife surgery (GKS) of arteriovenous malformations (AVMs) in the brain. Methods Twelve patients harboring brain AVMs referred for GKS underwent intraarterial digital subtraction (DS) angiography and time-resolved MR angiography while wearing an externally applied cranial stereotactic frame. Time-resolved MR angiography was performed on a 1.5-tesla MR unit (Achieva, Philips Medical Systems) using contrast-enhanced 3D fast field echo sequencing with stochastic central k-space ordering. Postprocessing with interactive data language (Research Systems, Inc.) produced hybrid data sets containing dynamic angiographic information and the MR markers necessary for stereotactic transformation. Image files were sent to the Leksell GammaPlan system (Elekta) for dosimetry planning. Results Stereotactic transformation of the hybrid data sets containing the time-resolved MR angiography information with automatic detection of the MR markers was possible in all 12 cases. The stereotactic coordinates of vascular structures predefined from time-resolved MR angiography matched with DS angiography data in all cases. In 10 patients dosimetry planning could be performed based on time-resolved MR angiography data. In two patients, time-resolved MR angiography data alone were considered insufficient. The target volumes showed a notable shift of centers between modalities. Conclusions Integration of time-resolved MR angiography data into the Leksell GammaPlan system for patients with brain AVMs is feasible. The proposed algorithm seems concise and sufficiently robust for clinical application. The quality of the time-resolved MR angiography sequencing needs further improvement.

scholarly journals Comparison of Contrast Enhanced Magnetic Resonance Angiography to Computed Tomography in Detecting Pulmonary Arteriovenous Malformations

2020 ◽  
Vol 9 (11) ◽  
pp. 3662
Author(s):  
Daniel A.F. Van den Heuvel ◽  
Marco C. Post ◽  
Ward Koot ◽  
Johannes C. Kelder ◽  
Hendrik W. Van Es ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Magnetic Resonance ◽  
Arteriovenous Malformations ◽  
Imaging Modality ◽  
Contrast Echocardiography ◽  
Pulmonary Arteriovenous Malformations ◽  
Reference Standard ◽  
Contrast Enhanced ◽  
Transthoracic Contrast Echocardiography ◽  
Sensitivity Specificity

Background: Computed tomography (CT) is considered the imaging modality of choice to diagnose pulmonary arteriovenous malformations PAVMs. The drawback of this technique is that it requires ionizing radiation. Magnetic resonance (MR) imaging does not have the limitation, but little is known about the performance of MR compared to CT for the detection of PAVMs. The aim of this study is to investigate the sensitivity of contrast-enhanced MR angiography (CE-MRA) in the detection of PAVMs with feeding artery diameters (FAD) > 2 mm. Methods: Patients with a grade 2 or 3 shunt on screening transthoracic contrast echocardiography (TTCE) were asked to participate. Included patients underwent chest CT and CE-MRA. CT was considered the reference standard. CT and CE-MRA scans were anonymized and assessed for the presence of PAVMs with FAD > 2 mm by one and two readers respectively. Data analysis was performed on per patient and per PAVM basis. Results: Fifty-three patients were included. 105 PAVMs were detected on CT, 45 with a FAD ≥ 2 mm. In per patient analysis, sensitivity and specificity of CE-MRA were 92% and 97% respectively for reader 1 and 92% and 62% for reader 2. Negative and positive predictive value (NPV/PPV) were 93% and 96% for R1 and 90% and 67% for R2. In per PAVM analysis, sensitivity, specificity, NPV and PPV were 96%, 99%, 100% and 86% for R1 and 93%, 96%, 100% and 56% for R2, respectively. Conclusions: CE-MRA has excellent sensitivity and NPV for detection of PAVMs with FAD ≥ 2 mm and can therefore be used to detect these PAVMs. We are hopeful that future advancements in CE-MRA technology will reduce false positive rates and allow for more broad use of CE-MRA in PAVM diagnosis and management.

Management of arteriovenous malformations of the brain stem

1986 ◽  
Vol 64 (6) ◽  
pp. 857-864 ◽  
Author(s):  
Robert A. Solomon ◽  
Bennett M. Stein
Keyword(s):  
Radiation Therapy ◽  
Brain Stem ◽  
Arteriovenous Malformations ◽  
Treated Group ◽  
Intracranial Arteriovenous Malformations ◽  
Content Type ◽  
Embolization Therapy ◽  
Complete Obliteration ◽  
The Brain ◽  
Fine Print

✓ In a series of 250 intracranial arteriovenous malformations (AVM's), 12 malformations involved the brain stem. Nine of these lesions were treated surgically, with complete obliteration in eight. There were no operative deaths, and only two patients were made worse by surgery. In the nonsurgically treated group, one patient had embolization therapy and two patients underwent radiation therapy. Results in these three patients have not been satisfactory. These data indicate that brain-stem AVM's can be surgically removed with acceptable morbidity.

scholarly journals Successful treatment of bilateral multiple pulmonary arteriovenous malformations in a patient with brain abscess and severe hypoxemia using a combination of transcatheter embolotherapy and surgical resection: a case report

2020 ◽  
Author(s):  
Takahiro Ochi ◽  
Masako Chiyo ◽  
Takamasa Ito ◽  
Hideharu Furumoto ◽  
Toshihiko Sugiura ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Brain Abscess ◽  
Surgical Resection ◽  
Arteriovenous Malformations ◽  
Pulmonary Arteriovenous Malformation ◽  
Positive Pressure ◽  
Pulmonary Arteriovenous Malformations ◽  
Severe Hypoxemia ◽  
History Of ◽  
The Brain

Abstract Background: A pulmonary arteriovenous malformation is an abnormal dilated blood vessel that makes direct communication between a pulmonary artery and pulmonary vein and can be associated with hypoxemia or neurological complications, including brain abscess and cerebral infarction. Treatment of pulmonary arteriovenous malformation includes surgical resection and transcatheter embolotherapy, however the adaptation of therapies should be considered when a patient is in bad condition.Case presentation: A 51-year-old man was admitted after developing fever, consciousness disorder, and hypoxemia. Magnetic resonance imaging of the brain showed a brain abscess. Bilateral pulmonary arteriovenous malformations were found by contrast computed tomography. Because of a family history of PAVM, a history of epistaxis, and the existence of oral mucosa telangiectasia, he was diagnosed with hereditary hemorrhagic telangiectasia and brain abscess caused by right-to-left shunt. The brain abscess improved with antibiotic treatment; however, the administration of oxygen did not ameliorate his hypoxemia. His hypoxemia was exacerbated by positive pressure ventilation. Considering his systemic and respiratory condition, we considered surgery to involve a high degree of risk. After controlling his brain abscess and pneumonia, transcatheter embolotherapy was performed. This improved his systemic condition, enabling surgical treatment.Conclusions: This middle-aged patient suffering from brain abscess and severe hypoxemia with multiple pulmonary arteriovenous malformations was successfully treated by a combination of transcatheter embolotherapy and surgery. The adaptation and combination of therapies, as well as the sequence of treatments, should be considered depending on the patient status and lesions.

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