title: Venous sac embolization of pulmonary arteriovenous malformation: safety and effectiveness at mid-term follow-up.
abstract: BACKGROUND
  The standard technique for the transcatheter treatment of pulmonary arteriovenous malformations (PAVMs) involves deploying coils into the feeding arteries. We investigated whether venous sac embolization would also be a safe and useful treatment method.
  
  
  OBJECTIVE
  To evaluate the safety and outcomes of venous sac embolization for PAVMs.
  
  
  METHODS
  This study included 15 consecutive patients (1 man, 14 women; mean age, 54 years; range, 22-76 years) with 50 PAVMs who underwent 26 procedures; four had a history of earlier cerebral infarction or exertional dyspnea. We first placed 0.018-inch interlocking detachable and/or 0.018-inch or 0.010-inch Guglielmi detachable coils to prevent systemic migration from the venous sac. We then packed the sac as tightly as possible and embolized the orifice at the proximal feeding artery. We used angiographic, clinical, and computed tomography (CT) studies to evaluate the treatment outcomes and safety of these procedures. The mean follow-up was 16 months (range, 3-63 months) in 12 patients with 43 PAVMs; three patients (7 PAVMs) were lost to follow-up.
  
  
  RESULTS
  Immediate post-embolization angiography confirmed complete primary occlusion in 47 of 50 lesions (94%). Minor complications arose in two of 26 procedures (7.7%); they were abnormal electrocardiograms without symptoms during and pleurisy immediately after the procedure. During follow-up, 40 PAVMs were free of CT evidence of reperfusion. The mean partial arterial oxygen pressure increased from 75.3% ± 13.6 before embolization to 85.4% ± 16.3 after embolization (P < 0.01, t-test). Of the 12 patients who were available for follow-up, none experienced new-onset paradoxical embolization; pre-treatment exertional dyspnea was alleviated in one patient. There were no major complications.
  
  
  CONCLUSIONS
  Venous sac embolization for PAVMs might be safe and more effective with no reperfusion than the standard pulmonary arterial embolization.
authors.affiliation: Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan kaji07kenji@yahoo.co.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kajiwara
authors.affiliation: Department of Radiology, Hiroshima City Hospital, Hiroshima, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Urashima
authors.affiliation: Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Takuji
authors.initials: T
authors.lastname: Yamagami
authors.affiliation: Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kakizawa
authors.affiliation: Department of Radiology, Hiroshima City Hospital, Hiroshima, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Matsuura
authors.affiliation: Department of Radiology, Hiroshima City Hospital, Hiroshima, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Matsuura
authors.affiliation: Department of Radiology, Hiroshima City Hospital, Hiroshima, Japan.
authors.forename: Tae
authors.initials: T
authors.lastname: Ohnari
authors.affiliation: Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Ishikawa
authors.affiliation: Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Awai
mesh_terms: D000328:Adult; D000368:Aged; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D004562:Electrocardiography; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: AVM; Vascular; adults; embolization; interventional; lung