Embolotherapy of pulmonary arteriovenous malformations with detachable balloons.

Abstract

Multiple pulmonary arteriovenous malformations (PAVM) present a difficult management problem, since surgical resection is unfeasible in most instances. Embolotherapy offers a viable alternative. Over a 2-yr period, detachable balloons were used to treat 16 PAVM in 5 patients, of whom 4 had severe hypoxemia and 1 had hemoptysis. Symptomatic improvement was achieved in all but 1 patient, in whom the largest could not be occluded because the balloon was too small. Two patients exhibited segmental pulmonary infarctions. Follow-up angiograms 4 mo. and 2 yr after occlusion demonstrated persistent obliteration of 14 PAVM without development of collateral supply; 2 required re-embolization due to enlargement of existing nonoccludeed feeders. Balloon embolization is safe and effective treatment of PAVM.