Kenji Kajiwara, Presenter: Nothing to Disclose

Masaki Urashima, Abstract Co-Author: Nothing to Disclose

Noriaki Matsuura, Abstract Co-Author: Nothing to Disclose

Hideaki Kakizawa, Abstract Co-Author: Nothing to Disclose

Masaki Ishikawa MD, Abstract Co-Author: Nothing to Disclose

Kazuo Awai MD, Abstract Co-Author: Research grant, Toshiba Corporation Research grant, Hitachi, Ltd Research grant, Bayer AG

Akiko Matsuura, Abstract Co-Author: Nothing to Disclose

Tae Onari, Abstract Co-Author: Nothing to Disclose

Venous sac embolization (VSE) for pulmonary arteriovenous malformations (PAVMs) tends to be avoided for fear of intra-procedural rupture and thrombus dislodgement. However, it prevents infarction of the adjacent normal lung tissue and collateral reperfusion by pulmonary and bronchial arteries. We evaluated the safety and outcome of VSE for PAVMs.

Fifteen consecutive patients (1 man, 14 women; mean age 54 years, range 22-76 years) with 50 PAVMs underwent arterial embolization during 26 procedures with a 3-F coaxial catheter system; 49 PAVMs were simple, the other was complex. Three patients were symptomatic and 3 (7 PAVMs) were lost to follow-up. The diameter of the feeding artery, venous sac, and draining vein ranged from 1-7 mm (mean 3.7 mm), 1-27 mm (mean 8.4mm), and 1-10 mm (mean 4.1 mm), respectively. We first placed interlocking detachable- or/and Guglielmi detachable coils (IDCs, GDCs) to prevent systemic migration in the venous sac. Then we packed the venous sac as completely as possible and embolized the proximal feeding artery with microcoils without occluding the normal branches. We used angiographic-, clinical-, and computed tomography (CT) studies to evaluate treatment outcomes and safety. Mean follow-up was 16 months (range 3-63 months) in 12 patients (43 PAVMs). We defined successful treatment as complete resolution of draining veins or as a decrease in their size by at least 70% and PAVM reperfusion as an increase in the diameter of the draining veins on follow-up CT scans.  

Complete primary occlusion on angiographs was achieved in 47 of 50 lesions (94%) without major complications. Minor procedure-related complications occurred in 2 procedures (7.7%); they were an abnormal electrocardiogram with no symptoms during- and pleurisy immediately after the procedure. Treatment was successful in 42 of 43 PAVMs (97.7%). Mean supine oxygen saturation increased from 75.3% ± 13.6 before- to 85.4% ± 16.3 after embolization in 12 patients (P < 0.01, t-test). During follow-up there was no PAVM reperfusion on CT and no patient exhibited signs of reperfusion or renewed onset of clinical symptoms.  

Despite our limited experience, VSE was useful for the treatment of PAVMs. More experience and long-term follow-up are needed to ascertain the value of this technique.

Mid-term follow-up suggested that VSE using IDCs or/and GDCs may be safe and effective to treat PAVMs.

Kajiwara, K, Urashima, M, Matsuura, N, Kakizawa, H, Ishikawa, M, Awai, K, Matsuura, A, Onari, T, Venous Sac Embolization of Pulmonary Arteriovenous Malformation: Effectiveness and Safety.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11003705.html