Indications

• Pulmonary AVMs with feeding arteries 2 mm or larger can be embolized.

  • • Historically, 3 mm was cutoff but newer evidence shows smaller AVMs should be considered.

    • Acceptable to follow <3 mm AVMs with CTA every few years.

    • Etiology: 80-90% of patients have HHT. Others may be due to trauma, surgery, malignancy, and hepatopulmonary syndrome.

Contraindications

• Relative:

  • • Left Bundle Branch Block (LBBB): as with other PA interventions, temporary pacer must be used to prevent complete heart block.

    • Contrast allergy (premedicate)

    • Renal impairment

Imaging Review

• CTA (PE CT): Localizes AVMs and delineates vascular supply

  • • Feeding artery 2 mm or greater

Tips for Workup

• EKG to assess for LBBB.

• Clinical status:

  • • Is patient able to tolerate the length of the procedure with moderate sedation?

    • Baseline neurologic exam needed due to risk of stroke.

    • Femoral DVT that would necessitate IJ access?

• Consent: Risk of non-target embolization of coil or air bubble à stroke, coronary occlusion or other end-organ ischemia; pleurisy is fairly common at 48 hrs; cardiac arrhythmia; contrast nephropathy; access site complications (rare, given venous access)