Pulmonary arteriovenous malformations: effect of embolization on right-to-left shunt, hypoxemia, and exercise tolerance in 66 patients.
OBJECTIVE
This study assessed the effect and safety of percutaneous transcatheter coil embolization of pulmonary arteriovenous malformations.


METHODS
In 58 (88%) of 66 patients, all malformations with feeding vessels greater than or equal to 3 mm in diameter were embolized with steel coils. Arterial oxygen saturation at rest and exercise, intrapulmonary right-to-left anatomic shunt fraction ((99m)Tc-macroaggregate injection), maximum exercise capacity (incremental work rate test), and pulmonary function were measured before and after embolization. Complications were analyzed.


RESULTS
Three categories of patients were identified. Patients in group 1 (27%) had complete occlusion of all angiographically visible pulmonary arteriovenous malformations; patients in group 2 (61%) had complete occlusion of all malformations with feeding vessels greater than or equal to 3 mm in diameter, but with smaller lesions persisting; and patients in group 3 (12%) had incomplete embolization, with feeding vessels greater than or equal to 3 mm in diameter remaining. The mean right-to-left shunt after embolization was least in group 1 (7%), intermediate in group 2 (10%), and greatest in group 3 (19%). Arterial oxygen saturation and right-to-left shunt fraction returned to normal levels (>96% and <3.5%, respectively) in 33% of patients. A significant improvement occurred after embolization in carbon monoxide diffusing capacity per unit of alveolar volume and in exercise capacity in 16 and 10 patients, respectively. In 93 procedures, 12 complications (13%) occurred.


CONCLUSIONS
Coil embolization of pulmonary arteriovenous malformations is effective in reducing right-to-left anatomic shunt fraction and in improving arterial oxygenation. Coil embolization of pulmonary arteriovenous malformations is well tolerated and has a low complication rate.
Department of Imaging, Imperial College Faculty of Medicine, Hammersmith Hospital, Du Cane Rd., London W12 0NN, England.
P
P
Gupta
C
C
Mordin
J
J
Curtis
J M B
JM
Hughes
C L
CL
Shovlin
J E
JE
Jackson
D000293:Adolescent; D000328:Adult; D000368:Aged; D001165:Arteriovenous Malformations / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000295:instrumentation; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D011652:Pulmonary Circulation; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging; D011859:Radiography; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin
D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D010100:Oxygen