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Ann Thorac Surg 1997;64:930-939
© 1997 The Society of Thoracic Surgeons

Original Article: General Thoracic

Embolotherapy of Large Pulmonary Arteriovenous Malformations: Long-Term Results

Daniel W. Lee, MD, Robert I. White, Jr, MD, Thomas K. Egglin, MD, Jeffrey S. Pollak, MD, Pierre B. Fayad, MD, Joel A. Wirth, MD, Melvin M. Rosenblatt, MD, Kevin W. Dickey, MD, Catherine M. Burdge, MSN

Departments of Diagnostic Radiology, Medicine, Pulmonary and Critical Care, and Neurology, Yale University School of Medicine, New Haven, Connecticut

Background. The purpose of this study was to document the long-term results of transcatheter embolotherapy of large pulmonary arteriovenous malformations (PAVMs).

Methods. From a data base of 221 consecutive patients with PAVMs treated by embolotherapy between 1978 and 1995, 45 patients with 52 PAVMs, supplied by feeding arteries 8 mm in diameter or larger, were selected for a retrospective investigation.

Results. Of 45 patients with 52 large PAVMs, 38 patients (84%) with 44 PAVMs (85%) were cured by the first embolotherapy (mean follow-up, 4.7 years). Acute periprocedural complications included self-limited pleurisy (31%), angina secondary to air embolus (2%), and paradoxical embolization of a device during deployment (4%). None of these events led to short- or long-term sequelae. Seven patients (16%) had persistence of the PAVM attributable to either recanalization (n = 4) or interim accessory artery growth (n = 3). Two of these patients presented with ischemic stroke several years after the initial treatment. Persistent PAVMs (n = 8) were retreated successfully by a second procedure (n = 7), or a third procedure (n = 1) (mean follow-up, 5.9 and 5.3 years, respectively).

Conclusions. Embolotherapy of large PAVMs results in permanent occlusion in an overwhelming majority of patients. Continued patency due to recanalization or accessory artery growth is easily detected and treated.






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