Embolotherapy for pulmonary arteriovenous malformations in the pediatric population with hereditary hemorrhagic telangiectasias - a retrospective case series.

Abstract

Purpose: To document the outcomes of embolotherapy for pulmonary arteriovenous malformation (pAVM) management, and investigate factors associated with pAVM persistence after embolotherapy in pediatric patients with hereditary hemorrhagic telangiectasia (HHT).

Materials and methods: Pediatric patients with HHT who received embolotherapy for pAVMs at the institute were retrospectively identified from January 1^st, 1999, to January 31^st, 2024. Cases with adequate clinical and imaging follow-up and without prior pAVM treatment at another institute were included. Demographic, clinical, and procedural data were obtained from the electronic health record. Univariate Cox proportional hazard models were used to determine factors associated with primary pAVM persistence (re-establishment of an arteriovenous connection in a pAVM after the first embolotherapy).

Results: Twenty-one patients (median age=15 years; range:3-19 years) underwent embolotherapy for 65 different pAVMs (Median follow-up time=7.56 years; range:0.13-24.4 years). In total, 3 procedural adverse events occurred. Primary persistence occurred in 23.1% of the treated pAVMs with recanalization only being the most common cause of (73.3%) followed by untreated feeders (20.0%) and recanalization along with formation of new collaterals to the pAVM (6.67%). Age less than the median cutoff of 15 years (p=0.044) and greater maximum diameter of the plugs/coils (p=0.011) were significantly associated with primary persistence on univariate analysis.

Conclusion: Embolotherapy of pAVMs in pediatric patients with HHT is safe, with a high rate of persistence when predominantly coils are used. The risk of primary persistence was associated with age less than 15 years, and the use of larger diameter plugs/coils.