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Diagnosis and Management of Persistent Pulmonary Arterio-venous Malformations following Embolotherapy

Journal

ACADEMIC RADIOLOGY
Volume 30, Issue 3, Pages 441-452

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.acra.2022.08.012

Keywords

Embolization; Pulmonary arteriovenous malformation (PAVM); Hereditary Haemorrhagic telangiectasia (HHT); Multidetector Computed Tomography; Time-resolved Magnetic Resonance Angiography (TR-MRA); Pulmonary angiogram

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Embolotherapy is the primary treatment for PAVMs, but a percentage of cases persist after embolization. Early identification and treatment of persistent PAVMs are crucial for preventing life-threatening complications. Technical challenges arise during repeat embolotherapy due to prior embolic devices and complex angioarchitecture. This article reviews patterns of persistence, factors affecting persistence, endovascular treatment techniques, and outcomes.
Embolotherapy is the primary treatment for pulmonary arterio-venous malformations (PAVMs). Approximately, 2-25% of PAVMs demon-strate persistence following embolization. Early identification and treatment of persistent PAVMs are critical to mitigating life threatening complications. The presence of prior embolic devices and complex angioarchitecture of persistent PAVMs pose technical challenges dur-ing repeat embolotherapy. In this article, we review patterns of persistence, factors affecting the persistence, endovascular treatment techniques, and outcomes.

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