Gulich Bianca, Buecker Arno, Schneider Guenther
Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, 66421 Homburg, Germany.
J Clin Med. 2024 Dec 20;13(24):7812. doi: 10.3390/jcm13247812.
The aim of this study was to evaluate patients with hereditary hemorrhagic telangiectasia (HHT) for the potential reperfusion of pulmonary arteriovenous malformations (PAVM) treated by catheter embolization using coils or embolization plugs and to analyze causes of possible reperfusion in order to further improve treatment. This retrospective study analyzed the data of 345 patients who underwent screening for pulmonary arteriovenous malformations in cases of suspected or confirmed HHT (Osler's disease). Of these, 118 patients with PAVM that underwent catheter embolization and had at least one follow-up study were included in our study and evaluated for potential reperfusion. Screening and follow-up for the detection of PAVM was performed by dynamic and high-resolution contrast-enhanced magnetic resonance angiography (MRA). The average follow-up time was 6.2 years. Reperfusion was detected in 43 of 118 patients at follow-up. Thirty-five of these patients showed a recanalization of the treated vessel and in eleven patients the formation of collateral vessels resupplying the PAVM were identified as the cause of reperfusion. The average time between embolization and detected reperfusion was 5.6 years. The recanalization of both coils and plugs was observed. The recanalization of coils could be attributed in most cases to an insufficient packing density of the implanted coils. In addition, an enlarged diameter of the feeding artery was confirmed as a risk factor for reperfusion. As the reperfusion of embolized pulmonary arteriovenous malformations can occur after a long time interval post-treatment, regular lifelong follow-up studies after embolization are essential to detect reperfusion at an early stage and avoid serious complications like a brain abscess or stroke through prompt re-embolization. After coil embolization, attention should be paid to sufficiently dense packing to achieve adequate and permanent occlusion.
本研究旨在评估遗传性出血性毛细血管扩张症（HHT）患者经导管使用弹簧圈或栓塞栓子栓塞治疗的肺动静脉畸形（PAVM）的潜在再灌注情况，并分析可能的再灌注原因，以进一步改进治疗。这项回顾性研究分析了345例疑似或确诊为HHT（奥斯勒病）而行肺动静脉畸形筛查患者的数据。其中，118例接受了导管栓塞治疗且至少有一次随访研究的PAVM患者纳入本研究，并评估其潜在再灌注情况。通过动态和高分辨率对比增强磁共振血管造影（MRA）进行PAVM检测的筛查和随访。平均随访时间为6.2年。随访时在118例患者中的43例检测到再灌注。其中35例患者显示治疗血管再通，11例患者中发现供应PAVM的侧支血管形成是再灌注的原因。栓塞与检测到再灌注之间的平均时间为5.6年。观察到弹簧圈和栓塞栓子均出现再通。弹簧圈再通在大多数情况下可归因于植入弹簧圈的填充密度不足。此外，供血动脉直径增大被确认为再灌注的一个危险因素。由于栓塞后的肺动静脉畸形再灌注可在治疗后很长一段时间间隔后发生，栓塞后定期进行终身随访研究对于早期检测再灌注以及通过及时再次栓塞避免脑脓肿或中风等严重并发症至关重要。弹簧圈栓塞后，应注意充分致密填充以实现充分和永久闭塞。
