Recurrence of Pulmonary Arteriovenous Malformation after Embolization in Patients with Pulmonary Hypertension.

PURPOSE: To evaluate the correlation between pulmonary hypertension (PH) and post-embolization pulmonary arteriovenous malformation (PAVM) recurrence.

MATERIALS AND METHODS: With IRB approval the records of 377 patients with PAVMs evaluated at single HHT center of excellence between January 1, 2013, and September 10, 2023, were retrospectively reviewed. PAVMs embolized during this time-period were evaluated for recurrence. Patients and PAVMs not treated during this time-period were excluded. Growth of previously untreated PAVMs was not considered recurrence. Patients without chest CT follow-up were excluded. General demographics, HHT status as defined by genetic testing or Curacao criteria, presence of PH, history of smoking, anemia, and liver AVMs was documented. Odds ratio and stratified analysis was calculated to assay the correlation between PAVM recurrence, PH and possible confounders.

RESULTS: A total of 151 patients with PAVMs were treated during the study period, including 438 PAVMs, for which follow-up was available. This included 106 patients with definite, 31 doubtful, and 14 possible HHT. The presence of pulmonary hypertension was significantly associated with both PAVM recurrence by patient (OR: 8.13, 95% CI 3.50 - 19.67) and by lesion (OR: 4.07, 95% CI 2.14 - 7.91). Multivariate analysis demonstrated that this correlation was independent of several variables including HHT status, smoking history, presence of liver AVMs, and anemia.

CONCLUSION: There is a high correlation between pulmonary hypertension and PAVM recurrence, likely due to high pulmonary artery pressures causing recanalization. Pulmonary hypertension may suggest the need for shorter surveillance intervals.