Pulmonary arteriovenous malformations treated with embolotherapy: helical CT evaluation of long-term effectiveness after 2-21-year follow-up

PURPOSE: To retrospectively evaluate the long-term results of transcatheter embolotherapy of pulmonary arteriovenous malformations (PAVMs) with helical computed tomography (CT). MATERIALS AND METHODS: Neither institutional review board approval nor patient consent was required for this retrospective study. Thirty-eight patients underwent follow-up helical chest CT 2-21 years after successful embolotherapy of 64 PAVMs. Four outcome categories were analyzed on the basis of the PAVM morphologic changes and perfusion findings seen on CT angiograms: successful treatment (marked reduction or disappearance of the aneurysmal sac), partially successful treatment (reduced size of the aneurysmal sac and pulmonary vessels, with feeding artery[ies] less than 3 mm in diameter, deemed too small to be occluded), partially failed treatment (reduced size of the aneurysmal sac and pulmonary vessels, with feeding artery[ies] larger than 3 mm and additional embolotherapy required), and failed treatment (similar size of or interim growth in the aneurysmal sac, with unchanged or enlarged pulmonary vessels). chi(2) or Fisher exact tests were used to analyze categorical variables; Mann-Whitney rank tests were used to analyze continuous variables. P < .05 was considered to indicate statistical significance. RESULTS: Long-term follow-up of the 64 occluded PAVMs revealed successful treatment of 30 (47%), partially successful treatment of 18 (28%), partially failed treatment of two (3%), and failed treatment of 14 (22%) PAVMs. The overall treatment success rate was 75% (47% plus 28%). Delayed recanalization requiring repeat embolotherapy occurred in 12 (19%) cases. No relationship between failed treatment and number of coils deposited in the feeding arteries was found. The frequency of gastrointestinal tract and/or hepatic arteriovenous fistulas at initial diagnosis (P = .01) and/or the interim development of pulmonary hypertension with or without heart failure (P = .01) was significantly higher in patients with at least one PAVM for which embolotherapy failed (n = 9) than in patients who underwent successful or partially successful embolotherapy of all PAVMs (n = 29). CONCLUSION: Long-term CT follow-up of initially successfully treated PAVMs revealed successful embolotherapy of 75% and partially or completely failed embolotherapy of 25% of PAVMs.