Correct!
2. Catheter pulmonary angiography with coil or detachable balloon embolization of the arteriovenous malformation
Catheter pulmonary angiography with coil or detachable balloon embolization of the arteriovenous malformation (typically coils or Amplatzer vascular plugs) is the therapy of choice for arteriovenous malformation. Surgical resection can be considered in selected cases not amenable to catheter pulmonary arterial embolization or for patients with arteriovenous communications that persist despite maximum embolotherapy, but is exceptional. Percutaneous placement of coils within the arteriovenous malformation is not the favored method for occlusion of the nidus; rather, endovascular therapy is the preferred route. While shunt assessment via breathing 100% oxygen is useful for establishing the physiological significance of an arteriovenous malformation, possibly as part of a screening regimen for at-risk patients (such as those with hereditary hemorrhagic telangiectasia), and for following treated patients to assess for potential recurrence, if it not required to determine the need for therapy for a lesion of this size. For such a large lesion, shunt is almost certainly present and significant; moreover, the large size of the lesion and associated vasculature place the patient at risk for systemic embolization, and therefore therapy is required to reduce the possibility of such, particularly stroke.
The patient underwent catheter pulmonary angiography (Figure 4) and coil embolization of the lingular arteriovenous malformation.
Figure 4. Catheter pulmonary angiogram in the arterial (A) and venous (B) phases just prior to placement of coils for embolization of the arteriovenous malformation shows the arterial (a) supply and central venous drainage (v). (C) Selective catheterization of the feeding artery (arrow) shows the lesion and the draining vein (arrowhead). (D) Occlusion of the feeding artery by coil embolization.
He recovered from the procedure without difficulty and his oximetry was normal. The post-embolotherapy thoracic CT (Figure 5) showed only minimal perfusion within the large lingular vascular nidus.
Figure 5. Panels A-F: staticaxial enhanced thoracic CT images displayed in lung windows, performed 6 months following coil embolotherapy, showing minimal enhancement in the anterior portion of the arteriovenous malformation (arrowheads). Coil occlusion of the feeding artery (arrows) is visible. Lower panel: movie of the enhancd CT displayed in lung images.
Diagnosis: Pulmonary arteriovenous malformation, treated with catheter pulmonary angiography embolotherapy.
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