title: Novel approach to complex pulmonary arteriovenous malformation embolization using detachable coils and Amplatzer vascular plugs.
abstract: BACKGROUND
  We evaluated the feasibility of a modified embolization technique of pulmonary arteriovenous malformations (PAVM) using venous sac embolization with detachable coils combined with the feeding artery embolization with the Amplatzer vascular plug (AVP).
  
  
  METHODS
  We retrospectively studied technical and clinical success in the treatment of 11 complexe PAVMs. We recorded number and size of feeding arteries and draining vein, the last prior and post treatment in the follow up CT, size of PAVMs; and the number of devices needed to occlude each PAVM.
  
  
  RESULTS
  11 complexe PAVM were treated with detachable coils to venous sac embolization followed by AVP to embolize feeding arteries. In all but one case a complete occlusion of the PAVM was angiographically achieved. The mean number of feeding vessel was 2.64 ± 0.92 (2-5). The mean number of coils was 7.82 ± 5.09 (3-20 coils). CT-follow-up, that was possible in 8 patients, showed a significant reduction of the draining vein size. The mean diameter reduction of the draining vein was 62 ± 18% varying between 29% and 77%. In all but one case with the complexe angioarchitecture the reduction of draining vein size close to 70% was achieved.
  
  
  CONCLUSIONS
  Our study implies that the venous sac embolization using the detachable coils followed by occlusion of the large feeding arteries using the AVP is a highly efficient method for the treatment of the complex PAVMs with large out-flow vessels and short feeding arteries.
authors.affiliation: Department of Radiology, Philipps University Marburg, Baldingerstrasse 35043, Marburg, Germany. hundt@med.uni-marburg.de
authors.forename: Walter
authors.initials: W
authors.lastname: Hundt
authors.forename: Mark
authors.initials: M
authors.lastname: Kalinowski
authors.forename: Andreas
authors.initials: A
authors.lastname: Kiessling
authors.forename: Johannes T
authors.initials: JT
authors.lastname: Heverhagen
authors.forename: Behfar
authors.initials: B
authors.lastname: Eivazi
authors.forename: Jochen
authors.initials: J
authors.lastname: Werner
authors.forename: Silke
authors.initials: S
authors.lastname: Steinbach
authors.forename: Klaus Jochen
authors.initials: KJ
authors.lastname: Klose
authors.forename: Mykhaylo
authors.initials: M
authors.lastname: Burbelko
mesh_terms: D000293:Adolescent; D000328:Adult; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; 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; D011859:Radiography; D012189:Retrospective Studies; D055989:Septal Occluder Device; D016896:Treatment Outcome; D055815:Young Adult