Pulmonary arteriovenous malformations treated with embolotherapy: Helical CT evaluation of long-term effectiveness after 2-21-year follow-up

Purpose: To retrospectively evaluate the long-term results of transcatheter embolotherapy of pulmonary arteriovenous malformations (PAVMs) with helical computed tomography (CT). Materials and Methods: Neither institutional review board approval nor patient consent was required for this retrospective study. Thirty-eight patients underwent follow-up helical chest CT 2-21 years after successful embolotherapy of 64 PAVMs. Four outcome categories were analyzed on the basis of the PAVM morphologic changes and perfusion findings seen on CT angiograms: successful treatment (marked reduction or disappearance of the aneurysmal sac), partially successful treatment (reduced size of the aneurysmal sac and pulmonary vessels, with feeding artery[ies] less than 3 mm in diameter, deemed too small to be occluded), partially failed treatment (reduced size of the aneurysmal sac and pulmonary vessels, with feeding artery[ies] larger than 3 mm and additional embolotherapy required), and failed treatment (similar size of or interim growth in the aneurysmal sac, with unchanged or enlarged pulmonary vessels). X-2 or Fisher exact tests were used to analyze categorical variables; Mann-Whitney rank tests were used to analyze continuous variables. P <.05 was considered to indicate statistical significance. Results: Long-term follow-up of the 64 occluded PAVMs revealed successful treatment of 30 (47%), partially successful treatment of 18 (28%), partially failed treatment of two (3%), and failed treatment of 14 (22%) PAVMs. The overall treatment success rate was 75% (47% plus 28%). Delayed recanalization requiring repeat embolotherapy occurred in 12 (19%) cases. No relationship between failed treatment and number of coils deposited in the feeding arteries was found. The frequency of gastrointestinal tract and/or hepatic arteriovenous fistulas at initial diagnosis (P =.01) and/or the interim development of pulmonary hypertension with or without heart failure (P =.01) was significantly higher in patients with at least one PAVM for which embolotherapy failed (n = 9) than in patients who underwent successful or partially successful embolotherapy of all PAVMs (n = 29). Conclusion: Long-term CT follow-up of initially successfully treated PAVMs revealed successful embolotherapy of 75% and partially or completely failed embolotherapy of 25% of PAVMs. (c) RSNA, 2006.