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Pulmonary Arteriovenous Malformations: Embolotherapy with Superselective Coaxial Catheter Placement and Filling of Venous Sac with Guglielmi Detachable Coils¹

¹ From the Department of Diagnostic Radiology, University of Bern, Inselspital, Freiburgstrasse 20, CH 3010 Bern, Switzerland. Received May 22, 2001; revision requested July 9; revision received September 26; accepted November 12. Address correspondence to H.P.D. (e-mail: hans-peter.dinkel@insel.ch).

PURPOSE: 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).

MATERIALS AND METHODS: 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.

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.

CONCLUSION: 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.

© RSNA, 2002

Index terms: Arteriovenous malformations, pulmonary, 94.149 • Arteriovenous malformations, therapeutic embolization, 94.1264 • Lung, vascular disease, 60.1494

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				R. I. White Jr, J. S. Pollak, D. Picus, H.-P. Dinkel, and J. Triller Are Guglielmi Detachable Coils Necessary for Treating Pulmonary Arteriovenous Malformations? * Drs Dinkel and Triller respond: Radiology, February 1, 2003; 226(2): 599 - 600. [Full Text] [PDF]