title: Amplatzer Vascular Plugs Versus Coils for Embolization of Pulmonary Arteriovenous Malformations in Patients with Hereditary Hemorrhagic Telangiectasia.
abstract: OBJECTIVE
  Coil embolization of pulmonary arteriovenous malformations (PAVMs) has a high re-canalization/re-perfusion rate. Embolization with Amplatzer plugs has been previously described, but the long-term efficacy is not established. This study reports the experience of a referral medical center with the use of coils and Amplatzer plugs for treating PAVMs in patients with hereditary hemorrhagic telangiectasia.
  
  
  METHODS
  The study was approved by the Institutional Review Board with waiver of informed consent. The cohort included all patients who underwent PAVM embolization in 2004-2014 for whom follow-up imaging scans were available. The medical files were retrospectively reviewed for background data, embolization method (coils, Amplatzer plugs, both), and complications. Re-canalization of treated PAVMs was assessed from intrapulmonary angiograms (following percutaneous procedures) or computed tomography angiograms. Fisher's exact test and Pearson Chi-squared test or t test were used for statistical analysis, with significance at p < 0.05.
  
  
  RESULTS
  16 patients met the study criteria. Imaging scans were available for 63 of the total 110 PAVMs treated in 41 procedures. Coils were used for embolization in 37 PAVMs, Amplatzer plugs in 21, and both in five. Median follow-up time was 7.7 years (range 1.4-18.9). Re-canalization was detected in seven vessels, all treated with coils; there were no cases of re-canalization in plug-occluded vessels (p = 0.0413).
  
  
  CONCLUSIONS
  The use of Amplatzer plugs for the embolization of PAVMs in patients with hemorrhagic telangiectasia is associated with a significantly lower rate of re-canalization of feeding vessels than coils. Long-term prospective studies are required to confirm these findings.
authors.affiliation: Department of Diagnostic Imaging, Rabin Medical Center - Beilinson and HaSharon Campuses, Petach Tikva, Israel. taunoam@gmail.com.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. taunoam@gmail.com.
authors.forename: Noam
authors.initials: N
authors.lastname: Tau
authors.affiliation: Department of Diagnostic Imaging, Rabin Medical Center - Beilinson and HaSharon Campuses, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Eliyahu
authors.initials: E
authors.lastname: Atar
authors.affiliation: Department of Pulmonology and National HHT Center, Schneider Children's Medical Center of Israel, 14 Kaplan Street, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Meir
authors.initials: M
authors.lastname: Mei-Zahav
authors.affiliation: Department of Diagnostic Imaging, Rabin Medical Center - Beilinson and HaSharon Campuses, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Gil N
authors.initials: GN
authors.lastname: Bachar
authors.affiliation: Institute of Pediatric Cardiology, Schneider Children's Medical Center of Israel, 14 Kaplan Street, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Tamir
authors.initials: T
authors.lastname: Dagan
authors.affiliation: Institute of Pediatric Cardiology, Schneider Children's Medical Center of Israel, 14 Kaplan Street, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Einat
authors.initials: E
authors.lastname: Birk
authors.affiliation: Institute of Pediatric Cardiology, Schneider Children's Medical Center of Israel, 14 Kaplan Street, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Elchanan
authors.initials: E
authors.lastname: Bruckheimer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001165:Arteriovenous Malformations / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D002648:Child; D000072226:Computed Tomography Angiography; 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; D012189:Retrospective Studies; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Amplatzer; Coils; Embolization; HHT; Hereditary hemorrhagic telangiectasia; OWR; Osler–Weber–Rendu; PAVM; Plugs; Pulmonary AVM; Re-canalization