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Does use of coils in addition to amplatzer vascular plugs prevent recanalization?
Scott O Trerotola1, Reed E Pyeritz
1Department of Radiology, Division of Vascular and Interventional Radiology, University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104, USA. streroto@uphs.upenn.edu
Insights
The Amplatzer vascular plug, used with coils, effectively treats pulmonary arteriovenous malformations (PAVMs), achieving complete occlusion. Follow-up CT scans confirmed no PAVM recanalization, demonstrating a safe and effective treatment option.
Area of Science:
- Interventional Radiology
- Vascular Surgery
- Cardiology
Background:
- Pulmonary arteriovenous malformations (PAVMs) can lead to serious complications.
- Recanalization of PAVMs after treatment with Amplatzer vascular plugs alone has been reported.
- Coils are often used in conjunction with vascular plugs for PAVM management.
Purpose of the Study:
- To evaluate the efficacy of using a type 1 Amplatzer vascular plug with at least one coil for PAVM treatment.
- To assess the rate of recanalization and overall success of this combined approach.
Main Methods:
- Retrospective review of 37 PAVMs in 30 patients treated with type 1 Amplatzer vascular plugs and coils.
- 39 feeder vessels were managed.
- Follow-up CT imaging was performed at 6 months and then every 3-5 years to assess for persistent perfusion, sac shrinkage, or resolution.
Main Results:
- Complete occlusion of all treated PAVMs was achieved.
- A mean of 1.5 coils were used per PAVM.
- Follow-up imaging in 24 patients (28 PAVMs) showed no recanalization, with sac shrinkage or disappearance in all cases.
Conclusions:
- The type 1 Amplatzer vascular plug, when used with coils, provides excellent and durable occlusion of PAVMs.
- This combined technique offers a safe and effective treatment option with no observed recanalization.
- Longer-term surveillance is recommended for all patients.
Objective:
Recanalization has been reported with the use of a type 1 Amplatzer vascular plug as the sole device to manage a pulmonary arteriovenous malformation (PAVM). We evaluated our experience with the use of at least one coil in addition to the vascular plug whenever possible in the treatment of patients with a PAVM.
Materials And Methods:
Thirty patients had 39 feeder vessels in 37 PAVMs managed with 39 type 1 Amplatzer vascular plugs. Eleven PAVMs (30%) were complex, and 26 (70%) were simple; nine (24%) were solitary. CT examinations were scheduled for 6 months after treatment and every 3-5 years thereafter. Scans were evaluated for persistent sac perfusion, sac shrinkage, and/or complete resolution of the PAVM.
Results:
Complete occlusion of all PAVMs was achieved. The mean number of coils used in addition to a type 1 Amplatzer vascular plug was 1.5 (range, 0-5 coils). Six patients did not participate in follow-up; 24 patients with 28 PAVMs managed with type 1 Amplatzer vascular plugs underwent follow-up imaging (mean, 13 months after treatment; range, 6-40 months). No PAVM exhibited recanalization at follow-up CT. Sac shrinkage or disappearance was found in all cases, and the plug had a characteristic CT appearance. Longer-term surveillance imaging was scheduled for all patients.
Conclusion:
Used in conjunction with coils, the type 1 Amplatzer vascular plug offers excellent occlusion of PAVMs. No recanalization was found in this study.
