Embolization of Macrovascular Pulmonary Arteriovenous Shunts in Hepatopulmonary Syndrome

Monday, April 13, 2026

4:57 PM - 5:03 PM ET

Location: 715

Abstract Presenter(s)

LE

Lindsay Eysenbach, MD

IR/DR Resident
University of Washington, United States

Author/Co-author(s)

AB

Anisha Banda, MD

Integrated IR Resident
University of Washington, United States
R. Torrance Andrews, MD, FSIR (he/him/his)

Interventional Physician
University of Washington, United States
AS

Avik Som, MD, PhD

Assistant Professor
University of Washington, United States

Learning Objectives:

Distinguish between type 1 and type 2 (macrovascular) hepatopulmonary syndrome

Describe interventional management of macrovascular pulmonary arteriovenous (AV) shunts in hepatopulmonary syndrome

Case study discussion of post-transplant patient who underwent staged embolization of multiple macrovascular pulmonary arteriovenous (AV) shunts

Background: Hepatopulmonary syndrome is a well-described complication of cirrhosis, with liver transplantation the only definitive treatment. While shunting is generally microvascular (type 1), patients can develop macrovascularAV shunts visible on computed tomography (CT) or angiography (type 2) that can be recalcitrant post transplant.

Clinical Findings/Procedure Details: We describe treatment of hepatopulmonary syndrome with serial embolization procedures in a patient six week post liver transplant with macroscopic AV shunts resulting in a high oxygenation requirement requiring ICU admission for high flow nasal cannula. CT showed multiple right lower lobe pulmonary AV shunts; ECHO confirmed large right to left shunt. After multidisciplinary discussion, staged pulmonary embolization was performed targeting the largest shunts. All procedures were performed with local anesthesia via right femoral vein access. Selective pulmonary angiography was performed. Each procedure focused on a single side (right), and targeted 2-3 macrovascular shunts identified on pre-procedure imaging. Shunts were embolized using coils or vascular plugs, depending on vessel size and anatomy. In total, three embolization procedures were performed over one month, with nine AV shunts embolized in total. Significant improvement in oxygenation was seen almost immediately with weaning of oxygenation requirements to 4L NC. The patient ultimately discharged to home and was able to resume work; at three month follow-up she reported symptomatic improvement.

Conclusion and/or Teaching Points:

Hepatopulmonary syndrome can result in macrovascular AV shunts amenable to embolization (type 2).

Embolization using previously described techniques for arteriovenous malformations is technically feasible and can improve symptoms in hepatopulmonary syndrome post-transplant.

Long-term outcomes and role in patients post-transplant to treat hepatopulmonary syndrome with macrovascular AV shunts is unknown but may be beneficial for oxygenation and stroke risk reduction.