Vessel Embolization: Transcatheter Embolization of Pulmonary Arteriovenous Malformations and Aortopulmonary Collateral Arteries

Abstract

Pulmonary arteriovenous malformations (PAVMs) are abnormal direct communications between the pulmonary artery and vein. Significant PAVMs can result in systemic hypoxemia with exertional dyspnea, paradoxical embolization with stroke, brain abscesses, and pulmonary hemorrhage with massive hemoptysis. Current guidelines recommend treatment for PAVMs when the feeding vessel is greater than 3 mm in diameter regardless of the presence of symptoms. Aortopulmonary collateral arteries (APCs) are frequently present in patients with cyanotic congenital heart disease and reduced pulmonary blood flow. Large or multiple collaterals can result in pulmonary overperfusion and symptomatic cardiac volume overload. Transcatheter embolotherapy has been established as the preferred treatment for both PAVMs and APCs. In this article, the physiopathology, clinical significance, occlusion technique, and potential complications for transcatheter embolization of these abnormal vessels are presented.