Does use of coils in addition to amplatzer vascular plugs prevent recanalization?
OBJECTIVE
Recanalization has been reported with the use of a type 1 Amplatzer vascular plug as the sole device to manage a pulmonary arteriovenous malformation (PAVM). We evaluated our experience with the use of at least one coil in addition to the vascular plug whenever possible in the treatment of patients with a PAVM.


METHODS
Thirty patients had 39 feeder vessels in 37 PAVMs managed with 39 type 1 Amplatzer vascular plugs. Eleven PAVMs (30%) were complex, and 26 (70%) were simple; nine (24%) were solitary. CT examinations were scheduled for 6 months after treatment and every 3-5 years thereafter. Scans were evaluated for persistent sac perfusion, sac shrinkage, and/or complete resolution of the PAVM.


RESULTS
Complete occlusion of all PAVMs was achieved. The mean number of coils used in addition to a type 1 Amplatzer vascular plug was 1.5 (range, 0-5 coils). Six patients did not participate in follow-up; 24 patients with 28 PAVMs managed with type 1 Amplatzer vascular plugs underwent follow-up imaging (mean, 13 months after treatment; range, 6-40 months). No PAVM exhibited recanalization at follow-up CT. Sac shrinkage or disappearance was found in all cases, and the plug had a characteristic CT appearance. Longer-term surveillance imaging was scheduled for all patients.


CONCLUSIONS
Used in conjunction with coils, the type 1 Amplatzer vascular plug offers excellent occlusion of PAVMs. No recanalization was found in this study.
Trerotola
Scott O
SO
Department of Radiology, Division of Vascular and Interventional Radiology, University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104, USA. streroto@uphs.upenn.edu
Pyeritz
Reed E
RE
D000293:Adolescent; D000328:Adult; D000368:Aged; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000002:abnormalities / Q000000981:diagnostic imaging; D011667:Pulmonary Veins / Q000002:abnormalities / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D055502:Secondary Prevention; D055989:Septal Occluder Device; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000000981:diagnostic imaging / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome