Embolization of pulmonary arteriovenous malformations: a comparison of the micro vascular plug system, amplatzer vascular plugs and coils

S58

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Monday

Scientific Session

MONDAY: Scientific Sessions

Seongnam-si, Republic of Korea; 2Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea. Purpose: Although bronchial artery embolization (BAE) is accepted as a standard treatment of major hemoptysis, little is known about its role in cryptogenic hemoptysis (CH). This study aimed to assess the safety and effectiveness of BAE using N-butyl-cyanoacrylate (NBCA) in patients with CH. Materials: Between May 2003 and March 2014, 27 patients (M:F¼21:6, mean 46.9 years) who underwent BAE for CH (negative finding on bronchoscopy and CT except aspirated blood) were enrolled in this study. A retrospective review was conducted for angiographic findings, technical and clinical success, complications, and recurrent hemoptysis. Results: Selective bronchial arteriograms were abnormal in 23 patients (85.2%: hypertrophied bronchial arteries [n¼20], parenchymal hypervascularity [n¼19], and bronchopulmonary shunt [n¼6]). All abnormal bronchial arteries (right [n¼18], left [n¼12]) were successfully embolized with NBCA. In 4 patients with normal angiographic findings (14.3%), unilateral bronchial arteries were embolized based on CT and/or bronchoscopic lateralization. Hemoptysis stopped within 24 hours in all patients. There was no major complication. During follow-up periods (ranged 11-117 months, median 54.6), 2 patients (7.4%) experienced recurrent hemoptysis at 5 and 11 months after BAE, which were treated with repeated embolization. The estimated hemoptysis-free survival rates were 96.3%, 92.3%, and 92.3% at 1, 3, and 5 years, respectively. Conclusions: Bronchial arteries were angiographically abnormal in a large proportion of patients (85.2%) despite negative finding on bronchoscopy and CT. BAE using NBCA is a safe and effective treatment in patients with CH.

3:27 PM

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JVIR

success was defined as occlusion of the feeding artery supplying the PAVM without evidence of residual flow through the PAVM. We examined total procedure time, fluoroscopy time, contrast dose and cost of the deployed devices. Results: All procedures were technically successful. At a mean follow up of 122 days using computed tomography angiography (18/45 patients), recanalization occurred in 4 DC cases, 4 AVP cases and 0 MVP cases. The results are displayed in the accompanying table. T-tests were performed between the embolic devices, with cost being the only statistically significant variable at po0.01 when comparing coils v. AVP and coils v. MVP. Conclusions: AVPs had the lowest procedure and fluoroscopy time and were the most cost effective. MVPs improved procedure time and were more cost effective than coils with the added benefit of microcatheter delivery allowing for embolization of smaller PAVMs. Coil

AVP

MVP

178.9 22

169.6 15.3

171.4 23.7

Mean Contrast Dose (mL) per PAVM

124.5

127.9

152.4

Mean Cost ($) per PAVM

$4,212.92

$965.77

$2,139.83

Mean Procedure Time (min) Mean Fluoroscopy Time (min) per PAVM

References 1. Pollak J, et al. Clinical and Anatomic Outcomes after Embolotherapy of Pulmonary Arteriovenous Malformations. JVIR 2006; 17(1):35–45. 2. Milic A, et al. Reperfusion of Pulmonary Arteriovenous Malformations after Embolotherapy. JVIR 2005; 16(12):1675–1683. 3. Fidelman N, et. al. Reperfusion of Pulmonary Arteriovenous Malformations after Successful Embolotherapy with Vascular Plugs. JVIR 2008; 19(8):1246– 1250.

Abstract No. 121 3:36 PM

Embolization of pulmonary arteriovenous malformations: a comparison of the micro vascular plug system, amplatzer vascular plugs and coils M. Towsley1, M. Towsley1, S. MacKenzie1, S. Mitchell1, C. Weiss1; 1Johns Hopkins Hospital, Baltimore, MD. Purpose: Transcatheter embolization remains the treatment of choice in Pulmonary Arteriovenous Malformations (PAVMs), whether using the detachable coil (DC), Amplatzer Vascular plug (AVP, St Jude Medical) or the recently developed MVP Micro Vascular Plug System (Reverse Medical). Coil embolization has been the traditional approach, but high recanalization rates ranging from 5%-15% (1, 2, 3) and the need for multiple coils has led to delivery systems that provide rapid occlusion with a single plug such as the AVP and MVP. This study was performed to compare all three embolic devices in the treatment of PAVMs. Materials: With the approval of the institutional review board, all patients treated for PAVMs between January 2012 and July 2015 were reviewed. Only patients receiving a single embolic device category (DC, AVP or MVP) were included in the study. The study contained 45 patients with 142 PAVMs (13 men, 32 women, mean age 43y±24y). 24 PAVMs were treated with DC, 39 with AVPs and 23 with MVP. Technical

Abstract No. 122

Embolotherapy of pulmonary arteriovenous malformations with the MVP micro vascular plug: technical success and short-term results B. Ishaque1, S. Hetts1, R. Kerlan1, M. Hope1, H. McGregor1, M. Dickey1, M. Wilson1, M. Conrad1; 1 University of California, San Francisco, San Francisco, CA. Purpose: To evaluate intraprocedural technical success and short-term results by computed tomography (CT) for transcatheter embolotherapy of pulmonary arteriovenous malformations (PAVMs) with the Micro Vascular Plug (MVP). Materials: Patients with PAVMs treated by MVPs between October 2014 and September 2015 were retrospectively reviewed. All patients were diagnosed with hereditary hemorrhagic telangiectasia. Data collected included age, gender, number and type of PAVM, feeding artery size, device migration, aneurysmal sac size and perfusion. Technical success was defined as immediate intraprocedural angiographic occlusion of the feeding artery beyond the plug. Successful treatment was defined as no PAVM persistence (no perfusion of the PAVM sac on follow up contrast-enhanced CT). MVP-3, MVP-5, and MVP-7 were chosen to embolize