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Pulmonary Arteriovenous Malformations Embolized Using a Micro Vascular Plug System: Technical Note on a Preliminary Experience

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An Erratum to this article was published on 17 November 2016

Abstract

AIM

To report our preliminary experience using a Micro Vascular Plug (MVP) deployed through a 2.8Fr micro-catheter for the treatment of pulmonary arteriovenous malformations (PAVMs) in a cohort of patients affected by Hereditary Haemorrhagic Telangiectasia (HHT).

Materials and Methods

Four consecutive female patients (mean age 38.0 years; range 25–55 years) with PAVMs diagnosed on echocardiogram/bubble test and contrast-enhanced CT (CECT) underwent MVP embolization. One patient was symptomatic with recent transient ischaemic attack. Follow-up was undertaken at 1-month post-procedure with CECT to assess PAVMs permeability and MVP positioning and at 1-, 6-, and 12-month post-procedure, with echocardiography/bubble test and standard neurological history, to confirm absence of right-to-left shunts and recurrent symptoms.

Results

Eight PAVMs were treated in 4 patients over 5 interventional sessions (mean 1.6 PAVMs per session). All PAVMs were simple, with mean feeding artery diameter of 4.25 mm. Eight 6.5 mm MVPs were deployed in total (one per lesion). Technical success was 100%. Mean procedural time and patient dose per session were 70 min (range 40–70 min) and 53418 mGy.cm2 (range 6113–101628 mGy.cm2), respectively. No signs of reperfusion neither of MPV migration were noted at 1-month CECT follow-up. At early follow-up (mean 3.75 months; range 1–12 months), clinical success was 100% with no evidence of recurrent right-to-left shunt, and no neurological symptoms. No immediate or late complications were observed.

Conclusions

MVP embolization of PAVMs appears technically feasible, safe, and effective at early follow-up. Further prospective studies are required to confirm long-term safety and efficacy of this promising technique.

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References

  1. Lacombe P, Lacout A, Marcy P, et al. Diagnosis and treatment of pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia: an overview. Diagn Interv Imaging. 2013;94:835–48.

    Article  CAS  PubMed  Google Scholar 

  2. Kjeldsen AD, Vase P, Green A. Hereditary haemorrhagic telangiectasia: a population based study of prevalence and mortality in Danish patients. J Intern Med. 1999;245:31–9.

    Article  CAS  PubMed  Google Scholar 

  3. Cottin V, Plauchu H, Bayle JY, et al. Pulmonary arteriovenous malformations in patients with hereditary haemorrhagic telangectasia. Am J Respir Crit Care Med. 2004;169:994–1000.

    Article  PubMed  Google Scholar 

  4. Cartin-Ceba R, Swanson KL, Krowka MJ. Pulmonary arteriovenous malformations. Chest. 2013;144(3):1033–44.

    Article  PubMed  Google Scholar 

  5. Faughnan ME, Palda VA, Garcia-Tsao G, et al. International Guidelines for the Diagnosis and Management of Hereditary Haemorrhagic Telangiectasia. J Med Genet. 2011;48:73–87.

    Article  CAS  PubMed  Google Scholar 

  6. Remy-Jardin M, Wattinne L, Remy J. Transcatheter occlusion of pulmonary arterial circulation and collateral supply: failures, incidents, and complications. Radiology. 1991;180:699–705.

    Article  CAS  PubMed  Google Scholar 

  7. Remy-Jardin M, Dumont P, Brillet PY, Dupuis P, Duhamel A, Remy J. Pulmonary arteriovenous malformations treated with embolotherapy: helical CT evaluation of long-term effectiveness after 2–21-year follow-up. Radiology. 2006;239:576–85.

    Article  PubMed  Google Scholar 

  8. Pollak JS, Saluja S, Thabet A, Henderson KJ, Denbow N, White RI Jr. Clinical and anatomic outcomes after embolotherapy of pulmonary arteriovenous malformations. J Vasc Interv Radiol. 2006;17:35–44.

    Article  PubMed  Google Scholar 

  9. Letourneau-Guillon L, Faughnan ME, Soulez G, et al. Embolization of pulmonary arteriovenous malformation with amplatzer vascular plugs: safety and midterm effectiveness. J Vasc Interv Radiol. 2010;21(5):649–56.

    Article  PubMed  Google Scholar 

  10. Funaki B. Embolization of pulmonary arteriovenous malformations. Semin Interv Radiol. 2007;24(3):350–5.

    Article  Google Scholar 

  11. Shimizu K, Yamazoe S, Ouchi K, Mogami T, Harada J. Embolotherapy of Pulmonary Arteriovenous Malformation Using Detachable Coils. Jikeikai Med J. 2012;59:37–43.

    Google Scholar 

  12. Dinkel HP, Triller J. Pulmonary arteriovenous malformations: embolotherapy with superselective coaxial catheter placement and filling of venous sac with Guglielmi detachable coils. Radiology. 2002;223:709–14.

    Article  PubMed  Google Scholar 

  13. Abdel Aal AK, Ibrahim RM, Moustafa AS, Hamed MF, Saddekni S. Persistence of pulmonary arteriovenous malformations after successful embolotherapy with Amplatzer vascular plug: long-term results. Diagn Interv Radiol. 2016;22(4):358–64.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tau N, Atar E, Mei-Zahav M, Bachar GN, Dagan T, Birk E. Bruckheimer E6. Amplatzer Vascular Plugs versus coils for embolization of pulmonary arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia. Cardiovasc Intervent Radiol. 2016;39(8):1110–4.

    Article  PubMed  Google Scholar 

  15. Trerotola S, Pyeritz R. Does Use of coils in addition to Amplatzer vascular Plugs prevent recanalisation? Am J Roentgenol. 2010;195(3):766–71.

    Article  Google Scholar 

  16. Trerotola SO, Pyeritz RE. PAVM embolization: an update. AJR Am J Roentgenol. 2010;195(4):837–45.

    Article  PubMed  Google Scholar 

  17. Pellerin O, Maleux G, Déan C, Pernot S, Golzarian J, Sapoval M. Microvascular plug: a new embolic material for hepatic arterial skeletonization. Cardiovasc Interv Radiol. 2014;37(6):1597–601.

    Article  Google Scholar 

  18. Shwe Y, Paramasivam S, Ortega-Gutierrez S, Altschul D, Berenstein A, Fifi JT. High-flow carotid cavernous fistula and the use of a microvascular plug system: initial experience. Interv Neurol. 2015;3(2):78–84.

    Article  PubMed  Google Scholar 

  19. Hao F, Powell D, Weintraub J, Sheynzon V. Pediatric Gastroduodenal Embolization with a Microvascular Plug. Cardiovasc Interv Radiol. 2016;39(5):788–90.

    Article  Google Scholar 

  20. Conrad MB, Ishaque BM, Surman AM, Kerlan RK Jr, Hope MD, Dickey MA, Hetts SW, Wilson MW. Intraprocedural safety and technical success of the MVP Micro Vascular Plug for embolization of pulmonary arteriovenous malformations. J Vasc Interv Radiol. 2015;26(11):1735–9.

    Article  PubMed  Google Scholar 

  21. Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol. 2003;14:S199–202.

    Article  PubMed  Google Scholar 

  22. Tacher V, Radaelli A, Lin M, Geschwind JF. How I do it: cone-beam CT during transarterial chemoembolization for liver cancer. Radiology. 2015;274(2):320–34.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Milic A, Chan RP, Cohen JH, Faughnan ME. Reperfusion of pulmonary arteriovenous malformations after embolotherapy. J Vasc Interv Radiol. 2005;16:1675–83.

    Article  PubMed  Google Scholar 

  24. Tapping CR, Ettles DF, Robinson GJ, et al. Long-term follow-up of treatment of pulmonary arteriovenous malformations with Amplatzer vascular Plugs and Amplatzer vascular plugs II devices. J Vasc Interv Radiol. 2011;22(12):1740–6.

    Article  PubMed  Google Scholar 

  25. Hart J, Aldin Z, Braude P, Shovlin C, Jackson J. Embolization of pulmonary arteriovenous malformations using the Amplatzer vascular plug: successful treatment of 69 consecutive patients. Eur Radiol. 2010;20:2663–70.

    Article  PubMed  Google Scholar 

  26. Microvascular plugs investigated in embolization of pulmonary arteriovenous malformations. Interventional News. Monday, 30 Nov 2015. http://www.cxvascular.com/in-features/interventional-news—features/microvascular-plugs-investigated-in-embolization-of-pulmonary-arteriovenous-malformations. Accessed 20 July 2016.

  27. Hamamoto K, Matsuura K, Chiba E, Okochi T, Tanno K, Tanaka O. Feasibility of non-contrast-enhanced mr angiography using the time-slip technique for the assessment of pulmonary arteriovenous malformation. Magn Resonance Med Sci. 2016;15(3):253–65.

    Article  Google Scholar 

  28. Schneider G, Uder M, Koehler M, Kirchin MA, Massmann A, Buecker A, Geisthoff U. MR angiography for detection of pulmonary arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia. AJR Am J Roentgenol. 2008;190:892–901.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Service de Imagerie Interventionelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Place de l’Hôpital, 67000, Strasbourg, France

    Emanuele Boatta, Christine Jahn, Julien Garnon, Roberto Luigi Cazzato & Afshin Gangi

  2. Service Service de Pneumologie, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Place de l’Hôpital, 67000, Strasbourg, France

    Matthieu Canuet

  3. Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK

    Nitin Ramamurthy

Authors
  1. Emanuele Boatta
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  2. Christine Jahn
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  3. Matthieu Canuet
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  4. Julien Garnon
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  6. Roberto Luigi Cazzato
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Correspondence to Roberto Luigi Cazzato.

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The authors declared that they have no conflict of interest to disclose.

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For this type of study formal consent is not required.

Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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was obtained from all individual participants included in the study.

Additional information

The original version of this article was revised: In the original article the name of the first author was misspelled as “Eanuele Boatta”. The correct spelling is “Emanuele Boatta”.

An erratum to this article is available at http://dx.doi.org/10.1007/s00270-016-1510-3.

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Boatta, E., Jahn, C., Canuet, M. et al. Pulmonary Arteriovenous Malformations Embolized Using a Micro Vascular Plug System: Technical Note on a Preliminary Experience. Cardiovasc Intervent Radiol 40, 296–301 (2017). https://doi.org/10.1007/s00270-016-1493-0

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