Abstract | OBJECTIVE: The purpose of this study was to determine the effects of percutaneous transcatheter coil embolization of pulmonary arteriovenous malformations on arterial oxygen saturation, pulmonary gas exchange, anatomic right-to-left shunt, and lung function and to assess the complications of the procedure. SUBJECTS AND METHODS: Fifty-three patients were included in the study: 42 (79%) had associated hereditary hemorrhagic telangiectasia. Nineteen (36%) had neurologic problems compatible with paradoxical embolization. During 102 separate embolization procedures, all malformations with feeding vessels > or = 3 mm in diameter were embolized with steel coils. Arterial oxygen saturation at rest and on exercise and the intrapulmonary right-to-left shunt fraction (99mTc-macroaggregate injection), forced expiratory volume in 1 sec, vital capacity, diffusing capacity for carbon monoxide, and transfer coefficient were measured before and after embolization. Complications of the procedure were recorded and investigated. RESULTS: Before treatment, all patients had hypoxemia in the supine posture (SaO2, 89 +/- 1% [standard error of the mean]), which fell a further 6% (absolute) on standing. Mean values for transfer coefficient and diffusing capacity for carbon monoxide were reduced, at 85 +/- 3% and 78 +/- 3% (predicted value), respectively. After embolization, the mean values for supine and erect SaO2 rose to 94 +/- 1% and 93 +/- 1%. Transfer coefficient increased by a mean of 5.4% of predicted value. The mean shunt fraction fell from 23 +/- 2% preembolization to 9 +/- 1% postembolization. In 102 procedures, there were 18 complications, 12 mild, two moderate, and four potentially serious (systemic coil embolization in two patients, cerebrovascular accident [transient], and myocardial puncture), but there were no lasting sequelae. CONCLUSION: Our results show that coil embolization is an effective and well-tolerated method for treatment of pulmonary arteriovenous malformations. Improvements in pulmonary gas exchange and lung function and a decrease in right-to-left shunting occurred after treatment. The procedure was well tolerated and had a low complication rate.
|
Authors | J A Dutton, J E Jackson, J M Hughes, M K Whyte, A M Peters, W Ussov, D J Allison |
Journal | AJR. American journal of roentgenology
(AJR Am J Roentgenol)
Vol. 165
Issue 5
Pg. 1119-25
(Nov 1995)
ISSN: 0361-803X [Print] United States |
PMID | 7572487
(Publication Type: Journal Article)
|
Chemical References |
|
Topics |
- Adolescent
- Adult
- Aged
- Arteriovenous Malformations
(blood, physiopathology, therapy)
- Child
- Embolization, Therapeutic
(adverse effects)
- Female
- Humans
- Male
- Middle Aged
- Oxygen
(blood)
- Prospective Studies
- Pulmonary Artery
(abnormalities)
- Pulmonary Circulation
- Pulmonary Veins
(abnormalities)
- Radiography, Interventional
- Respiratory Mechanics
- Telangiectasia, Hereditary Hemorrhagic
(therapy)
|