1 Department of Radiology, Hôpital Tenon, AP-HP, 4 Rue de la Chine, 75020 Paris, France.
2 Center of Excellence in Hereditary Hemorrhagic Telangiectasia, Hôpital Tenon, Paris, France.
AJR Am J Roentgenol. 2018 Nov;211(5):1135-1143. doi: 10.2214/AJR.17.19200. Epub 2018 Aug 30.
The purpose of this study is to assess the safety and efficacy of microvascular plugs for the treatment of pulmonary arteriovenous malformations (PAVMs).
From July 2014 to March 2017, 22 consecutive patients with hereditary hemorrhagic telangiectasia underwent treatment of PAVMs using microvascular plugs. The number, location, and type (simple or complex) of PAVM and the diameter of the feeding artery were assessed at angiography. Safety was evaluated by successful detachment and absence of migration of the microvascular plug after deployment. Efficacy was assessed by technical success, defined as immediate stasis in the feeding artery above the microvascular plug at the time of angiography, and by the persistence rate at 1-year follow-up CT.
Thirty-nine PAVMs (36 simple and three complex) were treated with 52 microvascular plugs in 22 consecutive patients. Thirty-three PAVMs were undergoing initial treatment and six were undergoing retreatment after previous embolotherapy. All microvascular plugs were successfully detached. No microvascular plug migration was observed. The mean (± SD) feeding artery diameter was 2.3 ± 0.7 mm. Technical success was achieved for 51 of 52 (98%) microvascular plug deployments. Follow-up CT, which was available for 20 of 22 (91%) patients, with a mean delay of 12.6 ± 3.1 months, showed two persistent PAVMs (persistence rate, 6%), one due to recanalization through the microvascular plug and the other due to reperfusion from an untreated adjacent pulmonary feeding artery.
Microvascular plugs are safe and effective for treatment of PAVMs, with a low persistence rate (6%) 1 year after treatment.
本研究旨在评估微血管塞治疗肺动静脉畸形（PAVMs）的安全性和有效性。
2014 年 7 月至 2017 年 3 月，22 例遗传性出血性毛细血管扩张症患者连续接受微血管塞治疗 PAVMs。在血管造影时评估 PAVM 的数量、位置和类型（单纯性或复杂性）以及供血动脉的直径。通过成功分离和部署后微血管塞无迁移来评估安全性。通过技术成功率评估疗效，定义为血管造影时在微血管塞上方的供血动脉立即停止，以及 1 年 CT 随访时的持续率。
22 例连续患者共治疗 39 个 PAVM（36 个单纯性和 3 个复杂性），共使用 52 个微血管塞。33 个 PAVM 正在进行初次治疗，6 个在先前栓塞治疗后进行再治疗。所有的微血管塞都成功地分离了。未观察到微血管塞迁移。平均（±SD）供血动脉直径为 2.3±0.7mm。52 个微血管塞中有 51 个（98%）的技术成功率。22 例患者中有 20 例（91%）获得了 12.6±3.1 个月平均延迟的随访 CT，显示 2 个 PAVM 持续存在（持续率为 6%），1 个是由于微血管塞再通，另 1 个是由于未治疗的相邻肺供血动脉再灌注。
微血管塞治疗 PAVMs 安全有效，治疗后 1 年的持续率（6%）较低。
