Embolization of Pulmonary Arteriovenous Malformations : Outcomes and Long-term Follow up in 10 Patients with Hereditary Hemorrhagic Telangiectasia

Background : Pulmonary arteriovenous malformations (PAVMs) complicated with hereditary hemorrhagic telangiectasia (HHT) are treated by embolotherapy with adaptation for afferent arteries ≥ 3 mm in diameter. Purpose : To evaluate the efficacy of embolotherapy in oxygenation and event-free survival, even with persistent untreated small PAVMs. Materials and methods : Ten consecutive patients with HHT and 35 PAVMs treated by embolotherapy were selected from a database between 1991 and 2009 for a retrospective investigation. We evaluated improvement in partial arterial oxygen pressure (PaO2) and right-to-left shunt and followed up the prevalence of long-term complications after embolotherapy. Results : Twenty-three PAVMs were cured by embolotherapy. Mean PaO2 increased from 69.0 ± 19.2 to 84.9 ± 19.6 torr after embolization (P=0.005) and right-to-left shunt improved from 25.7 ± 9.5 to 13.8 ± 6.3 (P=0.005). Oxygenation was similarly improved in six patients with small PAVMs outside of treatment adaptation. Although new embolic episodes did not arise, one patient developed reperfusion and untreated PAVMs grew in two others during a mean follow-up period of 69 months. Conclusions : Embolotherapy helped oxygenation and prevented paradoxical embolism even if small PAVMs remained untreated. However, frequent follow-up is necessary because untreated small PAVMs are at high risk for their growth.