Does use of coils in addition to amplatzer vascular plugs prevent recanalization?

Abstract

Recanalization has been reported with the use of a type 1 Amplatzer vascular plug as the sole device to manage a pulmonary arteriovenous malformation (PAVM). We evaluated our experience with the use of at least one coil in addition to the vascular plug whenever possible in the treatment of patients with a PAVM. Thirty patients had 39 feeder vessels in 37 PAVMs managed with 39 type 1 Amplatzer vascular plugs. Eleven PAVMs (30%) were complex, and 26 (70%) were simple; nine (24%) were solitary. CT examinations were scheduled for 6 months after treatment and every 3-5 years thereafter. Scans were evaluated for persistent sac perfusion, sac shrinkage, and/or complete resolution of the PAVM. Complete occlusion of all PAVMs was achieved. The mean number of coils used in addition to a type 1 Amplatzer vascular plug was 1.5 (range, 0-5 coils). Six patients did not participate in follow-up; 24 patients with 28 PAVMs managed with type 1 Amplatzer vascular plugs underwent follow-up imaging (mean, 13 months after treatment; range, 6-40 months). No PAVM exhibited recanalization at follow-up CT. Sac shrinkage or disappearance was found in all cases, and the plug had a characteristic CT appearance. Longer-term surveillance imaging was scheduled for all patients. Used in conjunction with coils, the type 1 Amplatzer vascular plug offers excellent occlusion of PAVMs. No recanalization was found in this study.