Ces radiol. 2012, 66(2):125-132

Endovascular treatment of pulmonary arteriovenous shuntsOriginal article

Antonín Krajina¹, Vladimír Koblížek², Miroslav Lojík¹, Jan Raupach¹, Vendelín Chovanec¹, Ondřej Renc¹, Eva Plodrová¹, Jan Hájek³, Leo Steinhart¹

¹ Radiologická klinika LF a FN, Hradec Králové

² Plicní klinika LF a FN, Hradec Králové

³ Radiodiagnostické oddělení Pardubické krajské nemocnice, a.s.

Aim: Results of the pulmonary arteriovenous shunts (PAVS) embolization therapy in prevention of paradoxical embolization are retrospectively analysed.

Material and methods: The study included 16 patients (7 males, 9 females of average age 48.3 years, range 17-82 years) with 35 PAVS. The single shunt was present in 6 patients, a shunt diagnosed on CT angiography was not confirmed on angiogram in one patient. The multiple PAVS (from 2 to 11) were diagnosed in 9 patients. The PAVS were in the left lung in one third of patients, in the right lung in another third of patients, and on the both sides in the remaining third of patients. The PAVS were located in the upper lobes only in 2 patients, who both had multiple PAVS. The other PAVS were located in the middle and lower pulmonary fields. The hemorrhagic hereditary teleangiectasia (HHT) was confirmed in 12 patients. The authors performed 18 embolization sessions, in two patients only diagnostic angiogram was done, since the PAVS was not confirmed in one patients and one patient was treated by pneumonectomy.

Results: All embolized PAVS were angiographically occluded in the end of the procedure. Recanalization of the PAVS occurred in 2 patients with dyspnoe. Another patient had reembolization of two PAVS after primary treatment in another hospital. One patient with epilepsy secondary to the brain abscess suddenly died 3 months after embolization, most probably due to epileptic seizure. One patient was lost for follow-up. Remaining patients have been doing well.

Conclusion: Embolization is the primary method of the PAVS occlusion in prevention of paradoxical embolization. The patients with HHT require permanent care.

Keywords: arteriovenous shunts, hemorrhagic hereditary telangiectasia, embolization, lung

Accepted: May 1, 2012; Published: June 1, 2012  Show citation