Pulmonary arteriovenous malformations: percutaneous treatment preserving parenchyma in high-flow fistulae

M Grosso, F Groppo Marchisio, F Testa, G Gallarato, A Balderi, G Lingua, I Mondino, F Pedrazzini, C Danesino, E Buscarini
La Radiologia Medica 2008, 113 (3): 395-413

PURPOSE: The aim of our study was to illustrate the benefits of percutaneous treatment by embolisation of high-flow pulmonary arteriovenous malformations (PAVM) in patients suffering from hereditary haemorrhagic telangiectasia (HHT; Rendu-Osler-Weber disease).

MATERIALS AND METHODS: From December 2001 to February 2007, we embolised 60 PAVMS in 35 procedures performed on 30 patients, all referred by the HHT centre in Crema, and enrolled in a screening programme of HHT families. All patients underwent clinical evaluation, contrast-enhanced ultrasound (CEUS) and spiral computed tomography (CT). Embolisation was made with nonmagnetic metallic coils via femoral venous access; an endovascular Amplatzer device was used in one patient only.

RESULTS: All embolisations were performed without difficulty. One patient only developed partial temporary aphasia, which resolved in 72 H. At spiral-CT follow-up, we generally demonstrated exclusion from circulation of treated PAVMS and regression of clinical symptoms. In the case of new lesions or recanalisation, further embolisation was possible:

CONCLUSIONS: Percutaneous embolisation has recently become the initial treatment option in PAVM owing to its good results and minimal invasiveness compared with thoracotomy. Our experience is in agreement with the literature: the procedure has a low complication rate, provides very good technical and clinical results and avoids resection of healthy pulmonary parenchyma.

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