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Multistage Ethanol Sclerotherapy of Soft-Tissue Arteriovenous Malformations: Effect on Pulmonary Arterial Pressure¹

¹ From the Departments of Anesthesiology and Pain Medicine (B.S.S., I.S.C., H.S.C., M.H.K., G.S.K., C.S.K.), Surgery (B.B.L., D.I.K.), and Radiology and Center for Imaging Science (Y.S.D., H.S.B., S.W.S., K.B.P.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul, 135–710 Korea. Received May 20, 2004; revision requested August 3; revision received August 26; accepted October 15. Address correspondence to Y.S.D. (e-mail: ysdo@smc.samsung.co.kr).

PURPOSE: To retrospectively investigate how repeat injections of absolute ethanol in therapeutic doses, required for multisession sclerotherapy of large high-flow soft-tissue arteriovenous malformations (AVMs) in patients with normal cardiopulmonary function, affect pulmonary arterial pressure (PAP).

MATERIALS AND METHODS: Study received approval and waiver of informed consent by institutional review board and was conducted in 16 male and 16 female patients with AVMs who underwent repeat sclerotherapy (142 sessions total) with absolute ethanol from July 1997 to December 2003. PAPs were monitored during first session in all patients. In subsequent sessions, PAP was monitored with pulmonary catheter when predicted single dose of ethanol exceeded 3 mL and total amount exceeded 0.25 mL/kg. PAP was measured in 104 sessions. Serum ethanol levels from blood samples obtained at end of each session were reviewed. PAP parameters were analyzed at beginning and end of each session, and highest value was recorded to assess any increase after repeat therapy. Difference between initial and highest PAP values recorded in a session (_max) was noted to determine any increase during repeat sessions. Possible relationship was reviewed between this value and amount of ethanol used. For sessions without PAP monitoring, mixed model was used for statistical analysis.

RESULTS: Total ethanol used was variable. In 43 sessions, highest mean PAP exceeded 25 mm Hg. Incidence of sustained pulmonary hypertension (mean PAP > 25 mm Hg) at end of each session was 30.8% (32 of 104 sessions). Initial PAP parameters did not increase or decrease during repeat sessions. No significant changes in _max of systolic and mean PAP were observed with increasing number of sessions. Rather, _max of diastolic PAP was reduced after repeat sessions (P = .03). There was no significant correlation between serum ethanol level and PAP parameters at end of sessions. Relationships between _max values of systolic, mean, and diastolic PAP and total ethanol used were not significant.

CONCLUSION: High incidence of acute pulmonary hypertension was observed in each sclerotherapy session without lasting effect on PAP.

© RSNA, 2005