Purpose: The purpose of this study was to review embolization outcomes of native pulmonary arteriovenous malformations (PAVMs) with specific attention to high-volume, soft, non-fibered coils (Penumbra Inc, Alameda, CA).
Material and Methods: A single center retrospective review was conducted on 103 consecutive patients who underwent embolization of native PAVMs between February 2008 and November 2018. PAVMs were stratified into those treated with coils only (n=231) and plugs only (n=20). The coil embolization group was further stratified into those treated with high-volume soft non-fibered coils only (group 1), those treated with a combination of high-volume soft non-fibered coils and other coils (group 2), and those treated with other coils only (group 3). Persistent occlusion on follow-up CT chest defined treatment success, while flow through or around the embolic defined treatment failure. ANOVA and Chi-squared tests were used for evaluation.
Results: Mean patient age was 44 years (10 - 87y), and 66.9% were female. 79.6% of AVMs were in patients with definite Hereditary Hemorrhagic Telangiectasia. Median follow up was 168 days (range, 32 – 3091 days). Overall treatment success was 87.3% (219/251) (Table 1). Persistent occlusion was achieved in 95.5% (21/22) of PAVMs in group 1, 94.1% (32/34) of PAVMs in group 2, and 84.6% of PAVMs in group 3 (148/175) (p=0.1). Success rate for use of high-volume soft non-fibered coils with or without other coils (group 1 + 2) was 94.6% (53/56) compared to 84.6% for use of other coils alone (p=0.05). Persistent occlusion rate using plugs was 90% (18/20), not significantly different from any of the coil groups (p=0.5). Median embolic cost per PAVM was $3080 for group 1, $4580 for group 2, $3100 for group 3, and $2495 for plug group (p=0.01).
Conclusions: The persistent occlusion rate of native PAVM coil embolization was higher when high-volume soft non-fibered coils were used. The success rate was similar between plugs and high-volume soft non-fibered coils.