SIR 2024
Embolization
Jose F. Saucedo, MD
Resident
University of California San Diego
Financial relationships: Full list of relationships is listed on the CME information page.
Emily Barnard, MD
Radiology Resident
UC San Diego
Financial relationships: Full list of relationships is listed on the CME information page.
Endovascular embolization of pulmonary arteriovenous malformations (PAVMs) was historically accomplished with embolic coils. With the advent of vascular plug devices and nidus filling techniques, the endovascular treatment of PAVMs has evolved to incorporate a growing diversity of devices and technical approaches. The purpose of this study is to
assess the intraprocedural technical success of PAVM embolization and PAVM persistence on follow up imaging utilizing only the Terumo Azur vascular plug in a limited cohort of patients.
Materials and Methods:
This retrospective study included a cohort of 12 patients who underwent primary embolization of 16 treatment-naïve PAVMs using the Azur device (13 simple, 3 complex PAVMs) between 2020 and 2023 at a single site. Distal embolization of the feeding artery was performed, with placement of the vascular plug just proximal to the nidus. After a period of 5 minutes, angiographic success was confirmed with post-embolization angiogram demonstrating occlusion at the level of the plug and absent filling of the PAVM. Persistence was evaluated on follow-up contrast enhanced computed tomography (CECT) between 1-15 months post-procedure. Persistence was defined as less than 70% reduction in PAVM sac size or contrast enhancement of the sac on follow-up.
Results:
Intraprocedural angiographic success rate for Azur plug only embolization was 16/16 (100%).
Follow-up imaging was available for 12 of the 16 treated PAVMs. On follow up CT, complete treatment response with no persistence ( >70% reduction) was achieved in 10/12 (83%) of the imaged PAVMs. Two out of twelve (17%) of treated PAVMs met criteria for persistence despite reduced size of nidus or draining vein. The total number of Azur plugs used was 22 (average 1.4 per PAVM). No major complications were encountered.
Conclusion:
The findings in this study support the clinical use of the Azur vascular plug device for the safe and effective treatment of PAVMs with a high technical success rate and rates of persistence comparable to published rates using alternative devices.