Daniel W. Lee, Robert I. White, Thomas K. Egglin, Jeffrey S

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Presentation transcript:

Embolotherapy of Large Pulmonary Arteriovenous Malformations: Long-Term Results Daniel W. Lee, Robert I. White, Thomas K. Egglin, Jeffrey S. Pollak, Pierre B. Fayad, Joel A. Wirth, Melvin M. Rosenblatt, Kevin W. Dickey, Catherine M. Burdge The Annals of Thoracic Surgery Volume 64, Issue 4, Pages 930-940 (October 1997) DOI: 10.1016/S0003-4975(97)00815-1

Fig. 1 (Patient 28.) A 56-year-old woman with left upper lobe pulmonary arteriovenous malformation and a right-sided hemiparesis secondary to paradoxical embolus. (A) Chest roentgenogram before treatment. (B) Selective left upper lobe pulmonary angiogram after occlusion of one segmental feeder to the pulmonary malformation (small arrowheads refer to branches, large arrowhead to segmental arteries). (C) Chest roentgenogram 1 day after occlusion. (D) Chest roentgenogram 1 year later. Note the deflated balloon shell remaining impacted within the thrombus and unmoved at 1 year after occlusion as indicated by visualization of the radiopaque bead present on gold-valve balloons (see text). (PO2 = oxygen tension.) The Annals of Thoracic Surgery 1997 64, 930-940DOI: (10.1016/S0003-4975(97)00815-1)

Fig. 2 (Patient 32.) This 33-year-old woman presented with a single large left lower lobe complex pulmonary arteriovenous malformation and exercise intolerance. (A and B) Arterial and venous phases, respectively, of the unoccluded pulmonary arteriovenous malformation. (C) Angiogram after occlusion. (D) Follow-up chest roentgenogram 9 years later. The feeding artery of this pulmonary arteriovenous malformation measured 16.1 mm in diameter, with a second contributory feeding artery lesser in size. Arrowheads in C refer to the balloon placed among the coils and a second balloon occluding an accessory feeder. In D, a residual aneurysm with calcified thrombus is identified (arrowheads). Note that the lone balloon placed within the accessory feeder remains inflated whereas the balloon impacted within coils has deflated. (PO2 = oxygen tension [in mm Hg].) The Annals of Thoracic Surgery 1997 64, 930-940DOI: (10.1016/S0003-4975(97)00815-1)

Fig. 3 (Patient 29.) This 12-year-old boy presented with cyanosis and dyspnea in 1992. (A, B) Selective left pulmonary angiogram arterial and venous phase. (C) Selective left lower lobe digital angiogram after occlusion of pulmonary malformation. (D) Computed tomogram at level of malformation 2 years later. (E) Selective left lower lobe digital angiogram in 1994. (F) Roentgenogram at end of second occlusion in 1994. (G) Selective pulmonary angiogram after second occlusion in 1994. Two accessory feeding arteries developed in this young patient between the first and second occlusions. Computed tomogram (D) shows a small residual mass distal to the two balloons. Arrowheads in E denote one of the accessory vessels that had developed. The arrowheads in F refer to this artery after a nest of coils was used to occlude it, and the angiogram after occlusion is shown in G. Two years later, the patient remained asymptomatic with a sitting, room air arterial oxygen tension of 94 mm Hg. The Annals of Thoracic Surgery 1997 64, 930-940DOI: (10.1016/S0003-4975(97)00815-1)