Comparing Microvascular Plug Embolization of the Distal Feeding Artery with Coil Embolization of the Nidus and Feeding Artery: Which Technique is More Effective for Pulmonary Arteriovenous Malformations?

Wednesday, April 2, 2025

10:30 AM – 10:39 AM CT

Location: Music City Center, 201 AB

Presenting Author(s)

Justin McWilliams, MD, FSIR

Professor of Interventional Radiology
David Geffen School of Medicine at UCLA, United States

Author/Co-author(s)

Dustin Roberts, MD

Fellow
UCLA Health, United States
Shanmukha Srinivas, MD

Resident Physician
UCLA, United States
Lucas R. Cusumano, MD, MPH

resident
ucla, United States

Purpose: Pulmonary arteriovenous malformations (PAVMs) are abnormal connections between the pulmonary artery and vein, bypassing the capillaries. Two of the most effective treatment techniques are microvascular plug embolization in the distal feeding artery (DFA-MVP) and coil embolization to occlude the nidus and feeding artery (NiFA-coil). However, direct comparative studies are limited. This research aims to compare the short-term outcomes of NiFA-coil and DFA-MVP techniques for PAVMs.

Materials and Methods: Retrospective chart review was conducted on patients who underwent either NiFA-coil or DFA-MVP embolization for PAVMs between October 2014 and May 2024, with follow-up chest CTA imaging performed within 14 months. PAVMs treated with both embolic agents were excluded. Treatment success was defined as ≥70% shrinkage of the nidus or draining vein on follow-up CT scans. Statistical analyses included Mann-Whitney U test for continuous variables and Fisher’s exact test for proportions.

Results: A total of 134 PAVMs (44 DFA-MVP, 90 NiFA-coil) in 80 patients, 76.3% (61/80) of whom had definite hereditary hemorrhagic telangiectasia (HHT), were reviewed. Overall treatment success was 97.0% (130/134 PAVMs) with a median follow-up of 4.1 months. Simple PAVMs were more common in the DFA-MVP group (93.1%, 41/44) compared to the NiFA-coil group (62.2%, 56/90) (p < 0.001). No significant difference was found in treatment success between NiFA-coil (96.7%, 87/90) and DFA-MVP (97.8%, 43/44) (p=1.000). On average, patients in the NiFA-coil group had larger feeding arteries (3.0 mm vs. 2.1 mm, p< 0.001) and larger sac sizes (6.2 mm vs. 4.1 mm, p=0.040).

Conclusion: Both NiFA-coil and DFA-MVP embolization techniques are highly effective for short-term treatment of PAVMs, showing comparable success rates.