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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).

View larger version (162K): [in a new window]   Images obtained in an 18-year-old patient with an asymptomatic PAVM in the right lower lobe of the lung. (a) Selective pulmonary angiogram obtained in the right pulmonary artery in an anteroposterior projection by using a 5-F cobra catheter shows a 2-cm PAVM (large arrow). Note the exceptionally large dilated draining vein (small arrow). (b) Superselective angiogram obtained in an anteroposterior projection through a 3-F coaxial microcatheter (arrow) before the deployment of GDCs shows that the microcatheter has been advanced into the venous compartment of the aneurysm. (c) Selective angiogram obtained in an anteroposterior projection shows the venous sac, which consists of two parts, being filled with electrolytically detachable GDCs (arrows). (d) Right selective pulmonary venous angiogram obtained in an anteroposterior projection demonstrates the complete occlusion of the PAVM. The feeding artery has been tightly filled with microcoils (arrows). One of the coils is protruding slightly into a segmental artery.

View larger version (111K): [in a new window]   Images obtained in an 18-year-old patient with an asymptomatic PAVM in the right lower lobe of the lung. (a) Selective pulmonary angiogram obtained in the right pulmonary artery in an anteroposterior projection by using a 5-F cobra catheter shows a 2-cm PAVM (large arrow). Note the exceptionally large dilated draining vein (small arrow). (b) Superselective angiogram obtained in an anteroposterior projection through a 3-F coaxial microcatheter (arrow) before the deployment of GDCs shows that the microcatheter has been advanced into the venous compartment of the aneurysm. (c) Selective angiogram obtained in an anteroposterior projection shows the venous sac, which consists of two parts, being filled with electrolytically detachable GDCs (arrows). (d) Right selective pulmonary venous angiogram obtained in an anteroposterior projection demonstrates the complete occlusion of the PAVM. The feeding artery has been tightly filled with microcoils (arrows). One of the coils is protruding slightly into a segmental artery.

View larger version (120K): [in a new window]   Images obtained in an 18-year-old patient with an asymptomatic PAVM in the right lower lobe of the lung. (a) Selective pulmonary angiogram obtained in the right pulmonary artery in an anteroposterior projection by using a 5-F cobra catheter shows a 2-cm PAVM (large arrow). Note the exceptionally large dilated draining vein (small arrow). (b) Superselective angiogram obtained in an anteroposterior projection through a 3-F coaxial microcatheter (arrow) before the deployment of GDCs shows that the microcatheter has been advanced into the venous compartment of the aneurysm. (c) Selective angiogram obtained in an anteroposterior projection shows the venous sac, which consists of two parts, being filled with electrolytically detachable GDCs (arrows). (d) Right selective pulmonary venous angiogram obtained in an anteroposterior projection demonstrates the complete occlusion of the PAVM. The feeding artery has been tightly filled with microcoils (arrows). One of the coils is protruding slightly into a segmental artery.

View larger version (191K): [in a new window]   Images obtained in an 18-year-old patient with an asymptomatic PAVM in the right lower lobe of the lung. (a) Selective pulmonary angiogram obtained in the right pulmonary artery in an anteroposterior projection by using a 5-F cobra catheter shows a 2-cm PAVM (large arrow). Note the exceptionally large dilated draining vein (small arrow). (b) Superselective angiogram obtained in an anteroposterior projection through a 3-F coaxial microcatheter (arrow) before the deployment of GDCs shows that the microcatheter has been advanced into the venous compartment of the aneurysm. (c) Selective angiogram obtained in an anteroposterior projection shows the venous sac, which consists of two parts, being filled with electrolytically detachable GDCs (arrows). (d) Right selective pulmonary venous angiogram obtained in an anteroposterior projection demonstrates the complete occlusion of the PAVM. The feeding artery has been tightly filled with microcoils (arrows). One of the coils is protruding slightly into a segmental artery.