Embolization of Pulmonary Arteriovenous Malformations

Pulmonary arteriovenous malformations (PAVM) may be sporadic or occur in association with hereditary hemorrhagic telangiectasia (HHT), also know as Osler-Webber-Rendu syndrome. Several centers nationwide have extensive experience dealing with the latter cohort of patients. These centers have multidisciplinary teams devoted to both diagnosis and treatment of this disease. However, it is not uncommon for patients to present to other hospitals with sporadic PAVMs or to present with initial signs and symptoms of HHT, such as exercise intolerance, stroke, or pulmonary hemorrhage.

Embolization has become the preferred method of treatment for symptomatic PAVMs and asymptomatic lesions > 3 mm in diameter. Incidentally, the 3-mm threshold is a relatively arbitrary criterion based on empirical observation. It was chosen when embolization of smaller lesions was technically impractical with the equipment available at the time. Currently, with the armamentarium of available microcatheters and embolic agents, some interventional radiologists will treat any and all lesions identified on pulmonary angiography. A comprehensive overview of treatment is beyond the scope of this brief article. Instead, I review three embolization techniques useful in the treatment of these lesions and applicable to a wider range of lesions with similar anatomy.

SUGGESTED READINGS

• 1 White R I, Pollak J S, Wirth J A. Pulmonary arteriovenous malformations: diagnosis and transcatheter embolotherapy.  J Vasc Interv Radiol. 1996;  7 787-804
• 2 Mager J J, Overtoom T T, Bauw H, Lammers J W, Westermann C J. Embolotherapy of pulmonary arteriovenous malformations: long-term results in 112 patients.  J Vasc Interv Radiol. 2004;  15 451-456
• 3 Pollak J S, Saluja S, Thabet A et al.. Clinical and anatomic outcomes after embolotherapy of pulmonary arteriovenous malformations.  J Vasc Interv Radiol. 2006;  17 35-44 , quiz 45