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

To assess the safety and effectiveness of transcatheter embolization for treatment of pulmonary arteriovenous malformations (PAVMs) and the clinical outcomes of patients after this procedure.

PubMed, Cochrane Library, and Embase databases were searched for studies on PAVM embolization published from January 2003 to December 2023 without language restrictions. Clinical studies with a sample size of 5 or more patients and 10 or more PAVMs were included. Technical success, persistence, and adverse events (AEs) were recorded. Embolization techniques were compared based on comparative studies.

A total of 54 studies were included in this meta-analysis. Based on available data, technical successful malformation occlusion was achieved in 98.3% by the end of embolization procedures (95% confidence interval [CI], 97.4%-99.3%) among 1,468 patients for whom these data were reported. The pooled persistence rate during follow-up was 13.2% (95% CI, 9.8%-16.7%) based on 2,946 patients. Using plugs was associated with a lower persistence rate than coils only (13.6% vs 32.7%; odds ratio [OR], 2.07; 95% CI, 1.04-4.13; P = .039). Venous sac embolization was associated with a lower persistence rate than feeding artery embolization (3.8% vs 24.3%; OR, 5.34; 95% CI, 2.32-12.27; P < .001). The pooled overall severe AE rate was 0.9% (95% CI, 0.4%-1.3%). The pooled rate for postembolization catastrophic event was 1.0% (95% CI, 0.2%-1.7%).

PAVM embolization has favorable technical and treatment success rates and low risk of severe AEs. Vascular plugs and venous sac coil embolization were associated with lower persistence. The current literature remains heterogeneous with limited correlation analysis between persistence and catastrophic events.