Pulmonary arteriovenous malformations: results of treatment with coil embolization in 53 patients

AJR Am J Roentgenol. 1995 Nov;165(5):1119-25. doi: 10.2214/ajr.165.5.7572487.


Objective: The purpose of this study was to determine the effects of percutaneous transcatheter coil embolization of pulmonary arteriovenous malformations on arterial oxygen saturation, pulmonary gas exchange, anatomic right-to-left shunt, and lung function and to assess the complications of the procedure.

Subjects and methods: Fifty-three patients were included in the study: 42 (79%) had associated hereditary hemorrhagic telangiectasia. Nineteen (36%) had neurologic problems compatible with paradoxical embolization. During 102 separate embolization procedures, all malformations with feeding vessels > or = 3 mm in diameter were embolized with steel coils. Arterial oxygen saturation at rest and on exercise and the intrapulmonary right-to-left shunt fraction (99mTc-macroaggregate injection), forced expiratory volume in 1 sec, vital capacity, diffusing capacity for carbon monoxide, and transfer coefficient were measured before and after embolization. Complications of the procedure were recorded and investigated.

Results: Before treatment, all patients had hypoxemia in the supine posture (SaO2, 89 +/- 1% [standard error of the mean]), which fell a further 6% (absolute) on standing. Mean values for transfer coefficient and diffusing capacity for carbon monoxide were reduced, at 85 +/- 3% and 78 +/- 3% (predicted value), respectively. After embolization, the mean values for supine and erect SaO2 rose to 94 +/- 1% and 93 +/- 1%. Transfer coefficient increased by a mean of 5.4% of predicted value. The mean shunt fraction fell from 23 +/- 2% preembolization to 9 +/- 1% postembolization. In 102 procedures, there were 18 complications, 12 mild, two moderate, and four potentially serious (systemic coil embolization in two patients, cerebrovascular accident [transient], and myocardial puncture), but there were no lasting sequelae.

Conclusion: Our results show that coil embolization is an effective and well-tolerated method for treatment of pulmonary arteriovenous malformations. Improvements in pulmonary gas exchange and lung function and a decrease in right-to-left shunting occurred after treatment. The procedure was well tolerated and had a low complication rate.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Arteriovenous Malformations / blood
  • Arteriovenous Malformations / physiopathology
  • Arteriovenous Malformations / therapy*
  • Child
  • Embolization, Therapeutic* / adverse effects
  • Female
  • Humans
  • Male
  • Middle Aged
  • Oxygen / blood
  • Prospective Studies
  • Pulmonary Artery / abnormalities*
  • Pulmonary Circulation
  • Pulmonary Veins / abnormalities*
  • Radiography, Interventional
  • Respiratory Mechanics
  • Telangiectasia, Hereditary Hemorrhagic / therapy


  • Oxygen