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Paradoxical Embolization in Untreated Recurrent Pulmonary Arteriovenous Malformations: Incidence and Risk Factors
Lucas Bitsko1, Qian Yu2, Rajangad Gurtatta1
1Division of Interventional Radiology, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Journal of Vascular and Interventional Radiology : JVIR
|April 27, 2026
Summary
Patients with recurrent pulmonary arteriovenous malformations (PAVMs) face a significant risk of paradoxical embolization (PDE). Untreated PAVM recurrence necessitates ongoing surveillance and potential reintervention due to persistent PDE risks.
Area of Science:
- Vascular Medicine
- Interventional Radiology
- Cardiology
Background:
- Pulmonary arteriovenous malformations (PAVMs) can recur after embolotherapy.
- Untreated recurrent PAVMs pose potential risks, including paradoxical embolization (PDE).
- Fragmented patient care can complicate management of recurrent PAVMs.
Purpose of the Study:
- To estimate the incidence of PDE in patients with untreated recurrent PAVMs.
- To explore patient- and lesion-level factors associated with PDE in recurrent PAVMs.
- To inform surveillance and reintervention strategies for recurrent PAVMs.
Main Methods:
- Retrospective review of patients with recurrent PAVMs after embolotherapy.
- Identification of patients with untreated recurrent PAVMs for ≥1 year.
- Calculation of PDE incidence and annualized event rates over patient-years of follow-up.
Main Results:
- Six of 15 patients (40%) with untreated recurrent PAVMs experienced PDE.
- The annualized PDE rate was 9.2 events per 100 patient-years.
- Larger lesions and greater recurrence burden were observed in patients with PDE, but not statistically significant.
Conclusions:
- Untreated recurrent PAVMs carry a persistent risk of paradoxical embolization.
- Ongoing surveillance and consideration of reintervention are warranted for patients with recurrent PAVMs.
- Larger studies are needed to further elucidate risk factors and optimize management.
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