Pulmonary Arteriovenous Malformation embolization: The Role of Contrast-Enhanced CT and Standardized Outcome Measures

Abstract

Purpose: To determine the pulmonary arteriovenous malformation (PAVM) persistence rate in patients treated with microcoils, vascular plugs, or a combination of these and to propose standardized outcome criteria using contrast-enhanced computed tomography (CT). Materials and Methods: This retrospective study included all adult patients undergoing embolization of de novo PAVMs using microcoils and/or Type I Amplatzer vascular plugs (AVP), between 2005 and 2012. PAVM persistence was assessed at 6 months using contrast-enhanced CT, focusing on vein enhancement vs shrinkage rates. Endpoints were overall persistence and persistence in technically successful treated de novo PAVMs. This was defined as confirmed occlusion of all embolized feeding arteries, embolization of ≤10 mm of the sac, and without missed feeding arteries. Results: The study included 113 patients (mean age, 42 years [SD ± 18]; 63 women), representing 292 PAVMs for analysis. Persistence was observed in 82 of 292 (28%) PAVMs and was angiographically confirmed in all cases. Of the persistent PAVMs, 16% showed >70% sac shrinkage on contrast-enhanced CT. Among 108 technically successful treated simple PAVMs, overall persistence was 11% (7% for Type I AVP and 21% for coils). Conclusions: Based on contrast-enhanced CT and with angiographical confirmation, overall PAVM persistence at 6 months after embolization with coils or AVPs was 28%. A suspected high sensitivity of contrast-enhanced CT for detecting PAVM persistence may partially account for outcome differences compared with those reported in previous studies and underscores the need for standardized imaging and reporting protocols.