PULMONARY ARTERIOVENOUS-MALFORMATIONS - RESULTS OF TREATMENT WITH COIL EMBOLIZATION IN 53 PATIENTS

OBJECTIVE. The purpose of this study was to determine the effects of p ercutaneous 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 comp lications of the procedure. SUBJECTS AND METHODS. Fifty-three patients were included in the study: 42 (79%) had associated hereditary hemorr hagic telangiectasia. Nineteen (36%) had neurologic problems compatibl e with paradoxical embolization. During 102 separate embolization proc edures, all malformations with feeding vessels greater than or equal t o 3 mm in diameter were embolized with steel coils. Arterial oxygen sa turation at rest and on exercise and the intrapulmonary right-to-left shunt fraction (Tc-99m-macroaggregate injection), forced expiratory vo lume 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. RESULT S. Before treatment, all patients had hypoxemia in the supine posture (SaO(2), 89 +/- 1% [standard error of the mean]), which fell a further 6% (absolute) on standing. Mean values for transfer coefficient and d iffusing capacity for carbon monoxide were reduced, at 85 +/- 3% and 7 8 +/- 3% (predicted value), respectively. After embolization, the mean values for supine and erect SaO(2) rose to 94 +/- 1% and 93 +/- 1%. T ransfer coefficient increased by a mean of 5.4% of predicted value. Th e mean shunt fraction fell from 23 +/- 2% preembolization to 9 +/- 1% postembolization. In 102 procedures, there were 18 complications, 12 m ild, two moderate, and four potentially serious (systemic coil emboliz ation in two patients, cerebrovascular accident [transient], and myoca rdial puncture), but there were no lasting sequelae. CONCLUSION. Our r esults show that coil embolization is an effective and well-tolerated method for treatment of pulmonary arteriovenous malformations. Improve ments in pulmonary gas exchange and lung function and a decrease in ri ght-to-left shunting occurred after treatment. The procedure was well tolerated and had a low complication rate.