Pulmonary Arteriovenous Malformations Embolized Using a Micro Vascular Plug System: Technical Note on a Preliminary Experience.
OBJECTIVE
To report our preliminary experience using a Micro Vascular Plug (MVP) deployed through a 2.8Fr micro-catheter for the treatment of pulmonary arteriovenous malformations (PAVMs) in a cohort of patients affected by Hereditary Haemorrhagic Telangiectasia (HHT).


METHODS
Four consecutive female patients (mean age 38.0 years; range 25-55 years) with PAVMs diagnosed on echocardiogram/bubble test and contrast-enhanced CT (CECT) underwent MVP embolization. One patient was symptomatic with recent transient ischaemic attack. Follow-up was undertaken at 1-month post-procedure with CECT to assess PAVMs permeability and MVP positioning and at 1-, 6-, and 12-month post-procedure, with echocardiography/bubble test and standard neurological history, to confirm absence of right-to-left shunts and recurrent symptoms.


RESULTS
Eight PAVMs were treated in 4 patients over 5 interventional sessions (mean 1.6 PAVMs per session). All PAVMs were simple, with mean feeding artery diameter of 4.25 mm. Eight 6.5 mm MVPs were deployed in total (one per lesion). Technical success was 100%. Mean procedural time and patient dose per session were 70 min (range 40-70 min) and 53418 mGy.cm2(range 6113-101628 mGy.cm2), respectively. No signs of reperfusion neither of MPV migration were noted at 1-month CECT follow-up. At early follow-up (mean 3.75 months; range 1-12 months), clinical success was 100% with no evidence of recurrent right-to-left shunt, and no neurological symptoms. No immediate or late complications were observed.


CONCLUSIONS
MVP embolization of PAVMs appears technically feasible, safe, and effective at early follow-up. Further prospective studies are required to confirm long-term safety and efficacy of this promising technique.
Service de Imagerie Interventionelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Place de l'Hôpital, 67000, Strasbourg, France.
Emanuele
E
Boatta
Service de Imagerie Interventionelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Place de l'Hôpital, 67000, Strasbourg, France.
Christine
C
Jahn
Service Service de Pneumologie, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Place de l'Hôpital, 67000, Strasbourg, France.
Matthieu
M
Canuet
Service de Imagerie Interventionelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Place de l'Hôpital, 67000, Strasbourg, France.
Julien
J
Garnon
Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
Nitin
N
Ramamurthy
Service de Imagerie Interventionelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Place de l'Hôpital, 67000, Strasbourg, France. gigicazzato@hotmail.it.
Roberto Luigi
RL
Cazzato
Service de Imagerie Interventionelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Place de l'Hôpital, 67000, Strasbourg, France.
Afshin
A
Gangi
D000328:Adult; D001165:Arteriovenous Malformations / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011651:Pulmonary Artery / Q000002:abnormalities*; D011667:Pulmonary Veins / Q000002:abnormalities*; D012189:Retrospective Studies; D016896:Treatment Outcome
Embolization; Hereditary hemorrhagic telangiectasia; Micro-Vascular Plug; Pulmonary arteriovenous malformations