Efficacy of Venous Sac Embolization for Pulmonary Arteriovenous Malformations: Comparison with Feeding Artery Embolization

Purpose: To examine the efficacy of venous sac embolization (VSE) in comparison with transcatheter feeding artery embolization (FAE) for treatment of pulmonary arteriovenous malformations (PAVMs). Materials and Methods: From 1989-2009, 21 patients underwent embolization of 37 PAVMs. Safety and long-term efficacy of VSE were evaluated retrospectively and compared with FAE. Results: FAE was performed in 22 (18 simple and 4 complex type) PAVMs, and VSE was performed in 15 (14 simple and 1 complex type) PAVMs. There were significant differences between FAE and VSE in treated periods, PAVM location, coil type used, number of coil combinations and coils per PAVM, coil position, and reperfusion; there were no significant differences in most PAVM characteristics, follow-up durations (58 mo +/- 54 vs 42 mo +/- 42; P = .32), and minor complications (pleurisy [2 vs 2]). Reperfusion occurred in 11(50%) of 22 PAVMs in the FAE group and no PAVMs in the VSE group (P < .01). Of 22 PAVMs in the FAE group, 17 (77%) were treated with 0.035-inch coils alone; of 15 PAVMs in the VSE group, 14 (93%) were treated with 0.018-inch interlocking detachable coils (IDCs), 0.018-inch pushable fibered coils, or IDCs and pushable fibered coils combined (P < .01). The number of coils used was 8 +/- 4 in the VSE group and 4 +/- 4 in the FAE group (P = .002). Conclusions: The high reperfusion rate in the FAE group was mainly due to the use of large 0.035-inch coils alone. Although more coils are needed, VSE can be used to treat PAVMs with a venous sac safely and achieve long-term efficacy.