Comparison of Feeding-Artery-Only versus Nidus-Plus-Feeding-Artery Embolization of Pulmonary Arteriovenous Malformations |
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Authors: | Dustin G Roberts Hiro D Sparks Lucas R Cusumano Sipan Mathevosian Gary R Duckwiler Justin P McWilliams |
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Institution: | 1. Division of Interventional Radiology, Department of Radiology, UCLA Health, Los Angeles, California;2. David Geffen School of Medicine, UCLA Health, Los Angeles, California |
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Abstract: | PurposeTo compare coil embolotherapy outcomes of feeding-artery-only versus nidus-plus-feeding-artery technique for treating pulmonary arteriovenous malformations (PAVMs).Materials and MethodsA total of 219 treatment-naïve PAVMs embolized in 90 patients at a single center from 2008 to 2018 met inclusion criteria for retrospective evaluation. Of the patients, 87% had a diagnosis of hereditary hemorrhagic telangiectasia (HHT). Feeding artery (FA) diameters ≥2 mm were treated. Coil embolization techniques were classified on the basis of embolic deployment zone: (i) distal feeding artery (DFA) technique (coil-to-nidus distance ≤ 1 cm) or (ii) nidus plus feeding artery (NiFA) technique. Successful embolization predictors were assessed using a multivariate linear regression model with input from patient- and PAVM-specific variables.ResultsTreatment success was achieved in 192 of 219 PAVMs (87.7%) over a mean follow-up period of 19 months. Statistically significant predictors of success in the linear regression model included simple angioarchitecture, NiFA embolization technique, and shorter follow-up duration. Stratified by technique, success rates were 99 of 105 (94.3%) and 93 of 114 (81.6%) PAVMs for NiFA and DFA, respectively (P = .007). On average, NiFA-embolized PAVMs had a larger FA diameter (3.6 mm vs 2.7 mm, P < .001) and comprised more complex PAVMs (48% vs 22%, P < .001) than DFA. Treatment success was not significantly associated with sac size or FA diameter.ConclusionsCoil embolization of both the nidus and FA was associated with a higher persistent occlusion rate than FA embolization alone. |
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Keywords: | CI"} {"#name":"keyword" "$":{"id":"kwrd0015"} "$$":[{"#name":"text" "_":"confidence interval DFA"} {"#name":"keyword" "$":{"id":"kwrd0025"} "$$":[{"#name":"text" "_":"distal feeding artery FA"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"feeding artery HHT"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"hereditary hemorrhagic telangiectasia NiFA"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"nidus plus feeding artery PAVMs"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"pulmonary arteriovenous malformations |
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