Cha Jung Guen, Park Jongmin, Park Byunggeon, Park Seo Young, Lee So Mi, Hong Jihoon
Kyungpook National University, School of Medicine, Department of Radiology, Daegu, Republic of Korea.
Diagn Interv Radiol. 2025 Mar 3;31(2):152-160. doi: 10.4274/dir.2024.242732. Epub 2024 Jun 3.
To evaluate the efficacy and safety of Amplatzer Vascular Plug 4 (AVP4) embolization in pulmonary arteriovenous malformations (PAVMs) with small- to medium-sized feeding arteries (<6 mm) and to identify factors affecting persistence and the main persistence patterns after embolization.
Between June 2013 and February 2023, we retrospectively reviewed 100 patients with 217 treated PAVMs. We included PAVMs with feeding arteries <6 mm, treated with AVP4 embolization, and followed adequately with computed tomography (CT). Technical success was defined as flow cessation observed on angiography. Persistence was defined as less than a 70% reduction of the venous sac on CT. We evaluated adverse events for each embolization session. Patterns of persistence were assessed using follow-up angiography. Univariate and multivariate analyses were performed to evaluate factors affecting persistence based on the 70% CT criteria.
Fifty-one patients (48 women, 3 men; mean age: 50.8 years; age range: 16-71 years) with 103 PAVMs met the inclusion criteria. The technical success rate was 100%. The persistence rate was 9.7% (10/103), and the overall adverse event rate was 2.9% (3/103) during a mean follow-up of 556 days (range: 181-3,542 days). In two cases, the persistence pattern confirmed by follow-up angiography involved reperfusion via adjacent pulmonary artery collaterals. The location of embolization relative to the last normal branch of the pulmonary artery was the only factor substantially affecting persistence.
Embolization with AVP4 appears to be safe and effective for small- to medium-sized PAVMs. The location of the embolization relative to the last normal branch of the pulmonary artery was found to be the main determinant of persistence.
Given the increasing demand for the treatment of small PAVMs, AVP4 embolization could be considered a viable and effective option for managing PAVMs with feeding arteries <6 mm.
评估Amplatzer血管封堵器4（AVP4）栓塞治疗供血动脉为小至中等大小（<6 mm）的肺动静脉畸形（PAVM）的疗效和安全性，并确定影响栓塞后病灶残留及主要残留模式的因素。
回顾性分析2013年6月至2023年2月期间100例接受治疗的217个PAVM患者。纳入供血动脉<6 mm、接受AVP4栓塞治疗且接受了充分计算机断层扫描（CT）随访的PAVM患者。技术成功定义为血管造影显示血流停止。残留定义为CT上静脉瘤囊缩小不到70%。评估每次栓塞治疗的不良事件。使用随访血管造影评估残留模式。基于CT上70%的标准，进行单因素和多因素分析以评估影响残留的因素。
51例患者（48例女性，3例男性；平均年龄：50.8岁；年龄范围：16 - 71岁）的103个PAVM符合纳入标准。技术成功率为100%。在平均556天（范围：181 - 3542天）的随访期间，残留率为9.7%（10/103），总体不良事件发生率为2.9%（3/103）。在2例病例中，随访血管造影证实的残留模式涉及通过相邻肺动脉侧支的再灌注。相对于肺动脉最后一个正常分支的栓塞位置是显著影响残留的唯一因素。
AVP4栓塞治疗小至中等大小的PAVM似乎是安全有效的。相对于肺动脉最后一个正常分支的栓塞位置是残留的主要决定因素。
鉴于对小PAVM治疗的需求不断增加，AVP4栓塞可被视为治疗供血动脉<6 mm的PAVM的可行且有效的选择。
