SIR 2024
Embolization
Nicholas Pudar, BS, RT
Medical Student
Rutgers New Jersey Medical School
Financial relationships: Full list of relationships is listed on the CME information page.
Mira Malavia, BA (she/her/hers)
Medical Student
University of Missouri-Kansas City School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Eduardo Bent Robinson, MD (he/him/his)
Resident Physician
Interventional Radiology University of Colorado Anschutz Medical Center
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Premal Trivedi, MD, MS
Associate Professor, Interventional Radiology
University of Colorado Anschutz Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Jonathan Lindquist, MD
Interim Vice Chair, Quality & Patient Safety and Clinical Operations
University of Colorado Department of Radiology
Financial relationships: Full list of relationships is listed on the CME information page.
Ken Hirasaki, MD
Assistant Professor, Radiology-Interventional
University of Colorado
Disclosure information not submitted.
James Hart, MD
Assistant Professor, Radiology-Interventional
University of Colorado
Disclosure information not submitted.
Leigh Casadaban, MD, MS
Assistant Professor
University of Colorado
Financial relationships: Full list of relationships is listed on the CME information page.
Pulmonary arteriovenous malformations (PAVMs) can persist after embolization 25-49% of the time {1}{2}. The reason for treatment failure is not well understood. This study examines a cohort of recanalized (flow through previous embolic treatment) or reperfused (flow through a recruited feeding vessel) PAVMs, including primary treatment characteristics, retreatment techniques and outcomes of repeat embolization.
Materials and methods:
This study retrospectively reviewed 19 patients who underwent 24 consecutive PAVM embolization procedures for persistent PAVMs with follow-up cross-sectional imaging at a single center between August 2014 and January 2022. Characteristics of the PAVMs were collected including simple vs complex, saccular vs non-saccular, primary embolic material, embolization of the nidus, type of persistence, retreatment data and reperfusion/recanalization on follow-up imaging. The success of repeat treatment was assessed on follow-up imaging. Chi-square test was used to compare groups.
Results:
Median patient age was 59 (range 9-71) and 42% were male. Seven patients with 10/24 (42%) PAVMs were primarily treated at an outside institution. Most PAVMs were simple (71%), saccular (71%) and primarily treated with coils (88%), rather than plug (4%) or coils and plug (8%). The nidus was primarily treated in only 4/24 (17%). Primary treatment recanalization was seen in 15/24 (62%), reperfusion in 7/24 (29%) and both in 2/24 (8%). Retreatment was performed with non-fibered coils (42%), fibered coils (29%), AVP and coils (21%) or Onyx (8%). Retreatment technical failure was 4/24 (7%) and an additional 3/24 (12%) reperfused on follow-up. Thus, 7/24 (29%) PAVMs had persistent flow on follow-up imaging with median follow-up of 31 months. Retreatment embolization into the nidus through the existing embolic or via a recruited vessel was achieved in 11/24 (46%). None of these demonstrated persistence on follow-up, however there was persistence when the nidus was not treated (7/13, 54%), (p=0.005). No correlation was seen between PAVM persistence and prior recanalization (p=0.68), prior reperfusion (p=0.54), simple (p=0.68) or saccular PAVM (p=0.68), retreatment with non-fibered coils (p=0.26), fibered coils (p=0.36) or AVP (p=0.54). No major procedural complications occurred.
Conclusion:
Retreatment of persistent PAVMs can achieve a high rate (83%) of technical success. Embolization of the nidus either through the existing embolization material or via a recruited pulmonary vessel with coils, plugs or liquid embolic can achieve high long-term occlusion.