Evolving strategies in pulmonary arteriovenous malformation embolization

Area of Science:

• Interventional Radiology
• Vascular Medicine
• Cardiology

Background:

• Pulmonary arteriovenous malformations (PAVMs) lead to right-to-left shunting, increasing risks of hypoxemia and paradoxical embolization.
• Endovascular embolization is the primary treatment for PAVMs, but its long-term success is influenced by various factors.

Purpose of the Study:

• To review contemporary evidence on embolic devices and techniques for PAVM treatment.
• To provide a decision framework for selecting appropriate embolization strategies based on lesion characteristics.

Main Methods:

• Narrative review synthesizing current evidence on embolic devices (coils, plugs, occluders, liquid embolics) and adjunctive techniques.
• Discussion of anatomy-, flow-, and imaging-based decision-making.

Main Results:

• Retrospective data suggest plug-based strategies may offer lower persistence in suitable PAVMs.
• Coils, liquid embolics, and hybrid approaches remain crucial for complex, recurrent, or anatomically constrained PAVMs.

Conclusions:

• An integrated approach considering anatomy, flow, and imaging is essential for optimal PAVM treatment.
• Structured long-term surveillance is critical to minimize PAVM persistence and enhance clinical outcomes.