Pulmonary arteriovenous malformations: embolotherapy with superselective coaxial catheter placement and filling of venous sac with Guglielmi detachable coils.

Abstract

To assess the value of superselective embolotherapy of pulmonary arteriovenous malformations (PAVMs) with coaxial microcatheters and 0.018-inch microcoils and to evaluate the technique of filling the venous sac with Guglielmi detachable coils (GDCs). Six consecutive patients (three men, three women; mean age, 46 years, age range, 18-74 years) underwent arterial embolization of nine PAVMs with superselective catheterization with a 3-F coaxial catheter system and embolization with 0.018-inch microcoils. The PAVMs varied in size from 1 to 6 cm (mean, 2.5 cm). Five of the lesions were also treated by filling the venous sac with GDCs. Success and outcome were evaluated by means of a review of patient records, angiographic findings, and telephone interview results. Complete primary occlusion was achieved in eight of nine lesions; repeat embolization resulted in successful occlusion of one lesion. The superselective technique enabled successful embolization in one patient after a previous procedure performed with a 0.035-inch (Gianturco) coil had failed. Filling of the venous sac was performed in the presence of dilated draining veins and enabled successful occlusion of the feeding artery with microcoils in all cases. There were no complications. Superselective embolization with microcatheters allowed easy catheterization and safe coil deployment. Filling of the venous sac reliably prevented systemic migration of GDCs in PAVMs with a large venous component.