Transarterial Embolization for Pulmonary Arteriovenous Malformation: A Systematic Review and Meta-Analysis

Area of Science:

• Interventional Cardiology
• Vascular Surgery
• Radiology

Background:

• Pulmonary arteriovenous malformations (PAVMs) are abnormal connections between pulmonary arteries and veins.
• Embolization is a primary treatment modality for PAVMs, aiming to occlude these abnormal vessels.
• Assessing the safety, effectiveness, and long-term outcomes of embolization is crucial for patient management.

Purpose of the Study:

• To evaluate the safety and effectiveness of transcatheter embolization for PAVMs.
• To analyze clinical outcomes, including technical success, persistence, and adverse events.
• To compare different embolization techniques for PAVMs.

Main Methods:

• A systematic meta-analysis of studies published between January 2003 and December 2023.
• Inclusion criteria: clinical studies with ≥5 patients and ≥10 PAVMs.
• Data extraction focused on technical success, persistence rates, and adverse events (AEs).

Main Results:

• Technical successful occlusion was achieved in 98.3% of 1,468 patients.
• The pooled persistence rate was 13.2% across 2,946 patients.
• Vascular plugs and venous sac embolization were associated with lower persistence rates compared to other methods. Severe AEs occurred in 0.9% and catastrophic events in 1.3%.

Conclusions:

• Transcatheter embolization demonstrates high technical and treatment success for PAVMs.
• Vascular plugs and venous sac embolization techniques are linked to reduced PAVM persistence.
• Further research is needed to address heterogeneity and correlation between persistence and catastrophic events.