Interventional occlusion of a large pulmonary arteriovenous malformation with an Amplatzer septal occluder

Interventional occlusion of pulmonary arteriovenous malformations with large feeding arteries may be associated with an increased risk of device embolization. In a 40-year-old patient with a solitary pulmonary arteriovenous malformation one large feeding artery was successfully closed by means of an Amplatzer septal occluder and detachable coils. The use of an Amplatzer septal occluder should be considered as an alternative therapeutic option in cases of huge pulmonary arteriovenous malformation to reduce the risk of device embolization.     

Transcatheter occlusion of a large pulmonary arteriovenous malformation

We report a patient with a large pulmonary arteriovenous malformation complicated by cerebral abscess. He was successfully treated by transcatheter embolization using bioptome-assisted delivery of multiple coils.     

Occlusion of a pulmonary arteriovenous fistula with an amplatzer vascular plug

Pulmonary arteriovenous malformations are rare anomalies that carry a considerable risk of serious complications such as cerebral thromboembolism or abscess and pulmonary hemorrhage. The first-line treatment of such malformations is detachable coil or balloon embolotherapy. However, coils and balloons may migrate and cause paradoxical embolism especially in malformations with large arteriovenous shunts. We report a case in which we used a new vascular occlusion device (amplatzer vascular plug), to occlude a pulmonary arteriovenous fistula in a patient with Rendu-Osler-Weber syndrome.     

Closure of an iatrogenic aortocoronary arteriovenous fistula: transcatheter balloon embolization following failed coil embolization and salvage of coils that migrated into the coronary venous system.

We report a 50-year-old patient with successful percutaneous closure of a large inadvertent surgical aortocoronary arteriovenous fistula (shunt flow: 1.8 L/min). With initial embolization of multiple coils, no lasting occlusion of the large fistula could be achieved. Above that, two coils migrated into the coronary venous system. Following rescue of the migrated coils through a retrograde coronary sinus approach, the fistula was occluded using a detachable balloon. Follow-up angiograms confirmed successful closure of the fistula. In contrast to coil embolization, use of a detachable balloon seems to be the appropriate technique for percutaneous closure of such fistulas.     

Transcatheter coil occlusion of hepatic arteriovenous malformation in a neonate

A 3-day-old neonate was diagnosed to have severe congestive heart failure due to a large shunt through a hepatic arteriovenous malformation. Percutaneous transcatheter delivery of two detachable coils resulted in complete abolition of the shunt. The patient showed dramatic clinical improvement and resolution of the heart failure, which was sustained on follow-up. This case represents a novel use of detachable occluding spring coils designed primarily for occluding patent ductus arteriosus.     

Transcatheter embolization of hepatic arteriovenous fistula in Osler-Weber-Rendu disease--a case report

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) is associated with arteriovenous fistulas throughout the body that can cause hemodynamic abnormalities. Owing to their size and extent, surgical repair is often not feasible. A patient referred for presumed valvular heart disease is described. On the basis of oximetry data at cardiac catheterization, a large intrahepatic arteriovenous fistula was discovered by aortography. This finding and a history of recurrent epistaxis were consistent with Osler-Weber-Rendu disease. Owing to the size of the fistula, embolization of the right hepatic artery with Gianturco coils was chosen as treatment, with resultant symptomatic improvement and decreased arteriovenous shunting.     

Embolisation procedures in congenital heart disease

Eight therapeutic embolisation procedures were performed by the transcutaneous catheter technique in seven patients with congenital heart disease. After surgical correction of tetralogy of Fallot (four patients), catheter embolisation was used to occlude two large aortopulmonary collaterals (one patient), three small aortopulmonary collaterals (one patient), and two Blalock-Taussig shunts (two patients). In two patients congenital coronary anomalies were occluded--a coronary arteriovenous malformation and a coronary artery/bronchial artery anastomosis. In one patient a pulmonary arteriovenous malformation was embolised. Detachable balloons were used to occlude six large arteries, the three small arteries were occluded with small gelfoam fragments, and the pulmonary arteriovenous malformation was occluded with multiple steel coils and large gelfoam pieces. Successful occlusion was achieved in all cases. No complications were encountered and the procedure was well tolerated even in the two patients receiving postoperative intensive care. Therapeutic embolisation in suitable cases is a safe and effective alternative to surgery and the detachable balloon technique is effective in occluding high flow vessels.     

Successful occlusion of multiple pulmonary arteriovenous fistulas using Amplatzer vascular plugs

Pulmonary arteriovenous fistulas, or malformations, are abnormal vascular connections between a pulmonary artery and a pulmonary vein. Clinical presentation may vary from asymptomatic patients to others showing a variety of symptoms such as cyanosis, dyspnea, high output heart failure, hemoptysis and paradoxical embolization. Initially, surgical treatment was the single method of therapy until several percutaneous embolization techniques using coils, coil bags, detachable balloons and devices were established. In this report, we describe a child in whom the new Amplatzer Vascular Plug device was successfully used to close multiple, large pulmonary arteriovenous fistulas.     

Embolisation procedures in congenital heart disease.

Eight therapeutic embolisation procedures were performed by the transcutaneous catheter technique in seven patients with congenital heart disease. After surgical correction of tetralogy of Fallot (four patients), catheter embolisation was used to occlude two large aortopulmonary collaterals (one patient), three small aortopulmonary collaterals (one patient), and two Blalock-Taussig shunts (two patients). In two patients congenital coronary anomalies were occluded--a coronary arteriovenous malformation and a coronary artery/bronchial artery anastomosis. In one patient a pulmonary arteriovenous malformation was embolised. Detachable balloons were used to occlude six large arteries, the three small arteries were occluded with small gelfoam fragments, and the pulmonary arteriovenous malformation was occluded with multiple steel coils and large gelfoam pieces. Successful occlusion was achieved in all cases. No complications were encountered and the procedure was well tolerated even in the two patients receiving postoperative intensive care. Therapeutic embolisation in suitable cases is a safe and effective alternative to surgery and the detachable balloon technique is effective in occluding high flow vessels.     

Transcatheter Device Occlusion of Multiple Large Pulmonary Arteriovenous Malformations in Two Symptomatic Pediatric Patients

Pulmonary arteriovenous malformations (AVMs) large enough to lead to clinically significant cyanosis are rare in the pediatric population. To date, there has been some experience with transcatheter embolization of pulmonary AVMs in children, primarily with coils or balloons. Herein, we report 2 cases of children who were progressively symptomatic and had physical manifestations of hypoxemia arising from large pulmonary AVMs. Both improved after successful catheter‐based placement of multiple occlusion devices (Amplatzer vascular plugs) in the pulmonary arterial segments feeding the AVMs produced a rapid, sustained increase in oxygen saturations, and a subsequent amelioration of their symptoms. This represents the first case series of multiple Amplatzer vascular plugs placed into numerous arteriovenous formations, exclusively in children. This approach represents an additional nonsurgical option for children or adults with symptomatic pulmonary AVMs.     

Successful occlusion of a coronary arteriovenous fistula using an Amplatzer duct occluder

In an 11-year old boy with a large coronary arteriovenous fistula between the left coronary artery and the right atrium, we achieved successful closure using a 10-8 Amplatzer Duct Occluder introduced from the right internal jugular vein. Angiography 6 weeks later showed complete occlusion of the fistula, with normal opacification of the left coronary arterial system. This technique may be used as an alternative to coils and surgery in selected patients.     

经静脉入路采用Onyx或联合弹簧圈治疗海绵窦区硬脑膜动静脉瘘的疗效

目的探讨经静脉入路采用Onyx或联合可脱性弹簧圈栓塞治疗海绵窦区硬脑膜动静脉瘘的安全性和有效性。方法回顾性分析2007年2月—2010年12月,经静脉入路栓塞治疗的12例海绵窦区硬脑膜动静脉瘘患者的临床资料,其中经岩下窦入路10例,经面静脉-眼上静脉入路2例。单独应用Onyx 8例,Onyx联合可脱性弹簧圈4例。结果①治疗后即刻血管造影显示完全闭塞10例,少量残留2例。单独应用Onyx栓塞治愈6例,好转2例,Onyx联合可脱性弹簧圈栓塞治愈2例,好转2例;总有效率100%,治愈率66.7%,无加重或死亡病例。②2例术中出现心动过缓,3例术后出现眶部疼痛。③对所有患者进行临床随访,随访时间为6～32个月,无复发及加重者。结论静脉入路Onyx或联合可脱性弹簧圈栓塞海绵窦区硬脑膜动静脉瘘的疗效确实,安全可靠。     

Percutaneous embolization of renal arteriovenous fistula

Acquired renal arteriovenous fistula is a rare complication following a nephrectomy and its diagnosis may be made many years after the intervention. The closure of the fistula is advisable in most cases, since it represents a risk for heart failure and rupture of the vessel. There are an increasing number of publications describing different techniques of occlusion. The case of a 70-year-old woman with abdominal discomfort due to a large renal arteriovenous fistula, 45 years after nephrectomy, is presented and current literature is reviewed. Percutaneous embolization was performed by placing an occluding balloon through the draining vein followed by the release of nine coils through arterial access. One day after successful occlusion of the fistula, clinical symptoms disappeared.     

Percutaneous occlusion of an latrogenic aortosaphenous vein-coronary vein fistula via retrograde coronary sinus approach

Inadvertent aortosaphenous vein graft-coronary vein anastomosis during coronary bypass surgery is an uncommon complication. We describe a case of aortosaphenous vein side-to-side anastomosis to an obtuse marginal vein resulting in a large arteriovenous fistula and elective closure, using embolization coils delivered percutaneously via the coronary sinus. The clinical findings, interventional procedure, and follow-up are also presented, with a discussion of alternative techniques used previously to treat latrogenic aortosaphenous vein graft venous fistulae. © 1996 Wiley-Liss, Inc.     

Transcatheter closure of a huge pulmonary arteriovenous fistula with embolization coils

A 46-year-old female with bilateral pulmonary arteriovenous fistulas was treated with Gianturco coil occlusion. The small right lung fistula was closed with a 6 mm coil, whereas the huge left lung fistula was occluded with three coils (one 10-mm and two 8-mm). Angiography 3 d later demonstrated recanalization of the left fistula. Two 8 mm coils were inserted to achieve complete obstruction again. She developed pulmonary infarction in the left lung 2 d later, which recovered without sequelae. We conclude that coil embolization for huge pulmonary arteriovenous fistula is feasible but may result in pulmonary infarction. Cathet. Cardiovasc. Diagn. 42:286–289, 1997.© 1997 Wiley-Liss, Inc.     

Right pulmonary artery to left atrium fistula: transcatheter closure without conventional venovenous loop

Right pulmonary artery to left atrium fistula is a rare anatomic variation of pulmonary arteriovenous malformation in which the initial connection exists between a pulmonary artery and a pulmonary vein, but during vascular development the pulmonary vein gets incorporated into the left atrium. Though nearly 60 such cases have been reported in literature, only 6 cases have been tackled by transcatheter technique with various types of devices and coils. This is a case where we demonstrate that large fistulae can be closed successfully with an atrial septal occluder without a conventional method of transseptal puncture and venovenous loop formation.     

Inferior mesenteric arteriovenous fistula associated with portal hypertension and acute ischemic colitis. Successful occlusion by intraarterial embolization with steel coils

The authors report a case of postoperative arteriovenous fistula between the inferior mesenteric vessels. This fistula was revealed by portal hypertension, with bleeding esophageal varices, ascites, and encephalopathy, and by acute ischemic colitis. Histologic examination of the liver was normal. All of the symptoms disappeared after transcatheter embolization of the fistula with stainless steel coils. This case report favors the reality of the so-called "forward" portal hypertension and suggests that inferior mesenteric arteriovenous fistula might be a factor predisposing to nonocclusive ischemic colitis.     

Transcatheter embolotherapy of maternal pulmonary arteriovenous malformations during pregnancy

Study objectives: To determine if transcatheter embolotherapy is safe and effective for the treatment of pulmonary arteriovenous malformations during pregnancy. DESIGN: Prospective study. SETTING: Specialized hereditary hemorrhagic telangiectasia centers at Yale University School of Medicine and St. Michael's Hospital, University of Toronto. PATIENTS: Seven pregnant women (age range, 24 to 34 years; gestational age range, 16 to 36 weeks) undergoing transcatheter embolotherapy. INTERVENTIONS: Transcatheter embolotherapy in all patients. Measurements and results: Thirteen pulmonary arteriovenous malformations in seven patients were embolized with detachable silicone balloons and/or stainless steel coils without incident. The estimated fetal radiation dose ranged from < 50 to 220 mrad. No complications of pulmonary arteriovenous malformations occurred in any of the patients after transcatheter embolotherapy. The mothers went on to deliver healthy babies in all cases. CONCLUSIONS: Transcatheter embolotherapy of maternal pulmonary arteriovenous malformations performed by an experienced radiologist appears to be safe and effective after 16 weeks of gestational age.     

Rare case of pulmonary arteriovenous fistula simulating residual defect after transcatheter closure of patent foramen ovale for recurrent paradoxical embolism.

We report on a patient suffering from recurrent cerebrovascular events despite previous transcatheter closure of persistent foramen ovale (PFO) with a Helex occluder. There was evidence of persistent left-to-right atrial shunt shown by transesophageal contrast echocardiography and the patient was admitted to our institution for interventional closure of the supposed residual defect. However, the PFO was completely closed by the device and left pulmonary artery injections showed a pulmonary arteriovenous fistula in the left lower lobe. This rare malformation may well explain the recurrent paradoxical embolism. Transcatheter fistula closure with coils was performed successfully. This case underlines that the existence of an isolated pulmonary arteriovenous fistula as a right-to-left shunt in patients with cryptogenic stroke should not be overlooked, even if a PFO is present and pulmonary arteriovenous fistula is not suggested by the initial physical findings or chest X-ray.     

Three cases of transcatheter embolization for pulmonary arteriovenous fistula using detachable coils]

We report three cases of transcatheter embolization for pulmonary arteriovenous fistula (PAVF) using Interlocking detachable coils (IDC) and detachable fibered coils (DFC), and evaluate the outcome of transcatheter embolization with reference to previous reports. The three patients were women aged 56, 70 and 71 years. They had no symptoms, but chest radiographs were abnormal. None of them had Rendu-Osler-Weber disease. The three PAVFs were of the simple type, with a single feeding vessel and a single draining vein. In case 1, the feeding vessel arose from the left A4, while the feeding vessels in case 2 and 3 arose from the left A5. In case 1, we embolized the venous sac with detachable coils because the feeding vessel was short and kinked. In case 2 and 3, we embolized the feeding vessels closer as to the neck of the venous sac using detachable coils. The three PAVFs were all successfully embolized without severe complications, and transcatheter embolization seems to be an effective therapy.