From the Guidelines
Coil embolization is the recommended treatment for pulmonary arteriovenous malformations (PAVMs) due to its effectiveness in reducing the risk of paradoxical embolism and improving symptoms. According to the American College of Radiology Appropriateness Criteria 1, any PAVM detected by CT or catheter angiography should be considered for treatment, regardless of the size of the feeding artery. The procedure involves deploying coils or plugs in the feeding artery as close to the arteriovenous communication as possible, with success rates exceeding 95% 1.
Key Considerations
- The treatment of PAVMs involves endovascular occlusion of the feeding artery, with percutaneous transcatheter embolization being the typical approach 1.
- Embolization is performed by deploying coils or plugs in the feeding artery, with coils alone having a persistence rate of 5% to 21% 1.
- Follow-up CT angiography is recommended within 6 to 12 months after embolization to detect persistence or new lesions, and then every 3 to 5 years 1.
- Persistent perfusion of PAVMs following embolization carries the continued risk of paradoxical embolism, with re-treatment success rates ranging from 44% to 85% 1.
Clinical Implications
- Coil embolization is generally recommended for symptomatic pulmonary AVMs or those larger than 3mm in feeding artery diameter, even if asymptomatic, due to the risk of paradoxical embolism 1.
- Patients with hereditary hemorrhagic telangiectasia (HHT) are at higher risk of developing PAVMs, with 70% to 90% of patients with PAVMs having HHT 1.
- Pregnancy is associated with the rapid growth of PAVMs, increasing the risk of complications from lack of filtration and rupture 1.
From the Research
Coil Embolization for AV Malformation in the Lung
- Coil embolization is a treatment option for pulmonary arteriovenous malformations (AVMs), which are abnormal vascular communications between the pulmonary arteries and pulmonary veins 2.
- The goal of coil embolization is to exclude the AVM from the circulation, thereby preventing right-to-left shunting and improving oxygenation 3.
- The procedure involves the use of detachable coils, which can be precisely placed and repositioned prior to detachment, allowing for safe and controllable exclusion of the AVM 4.
- Coil embolization has been shown to be an effective and safe procedure, with significant reduction in right-to-left shunting and improvement in arterial oxygen saturation 3.
- Different types of coils, such as platinum and stainless-steel coils, can be used for embolization, with no significant difference in success rates between the two 5.
- Other occlusive devices, such as the Amplatzer vascular plug, can also be used for embolization of large high-flow vessels, such as those found in pulmonary AVMs 6.
- Complications of coil embolization can occur, including coil reflux, PAVM perforation, and systemic embolization of a coil, but are generally rare and self-limited 5.