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Published in: CardioVascular and Interventional Radiology 3/2019

01-03-2019 | Clinical Investigation

MVP™ Micro Vascular Plug Systems for the Treatment of Pulmonary Arteriovenous Malformations

Authors: Christopher R. Bailey, Anirudh Arun, Matthew Towsley, Won Kyu Choi, Joshua F. Betz, Stacey MacKenzie, Moustafa Abou Areda, Madhavi Duvvuri, Sally Mitchell, Clifford R. Weiss

Published in: CardioVascular and Interventional Radiology | Issue 3/2019

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Abstract

Purpose

To describe our institutional experience with MVP™ micro vascular plug systems for the treatment of pulmonary arteriovenous malformations (PAVMs).

Materials and Methods

We performed a retrospective medical record review of 52 patients with 119 PAVMs treated exclusively with MVP™ systems (69 procedures/153 MVP™ systems) between July 2014 and July 2018. All patients had PAVMs with feeding artery diameters ≥ 2 mm. MVP™ systems were deployed according to physician preference. We collected patient demographic information; procedural data (including size of feeding artery, size and number of embolics used per PAVM, fluoroscopy time, contrast administration), technical success rates, complications, and persistence. Persistence was assessed using computed tomography angiography (CTA) performed 1–3 months and 3–5 years after embolization per clinical protocol.

Results

All procedures were technically successful without major complications. Mean feeding artery diameter was 3.3 ± 1.2 mm. Mean fluoroscopy time per procedure and contrast volume administered per procedure were 35 ± 16 min and 217 ± 101 mL, respectively. A mean of 1.3 ± 0.8 MVP™ systems was used per PAVM. There were no instances of persistence during a mean follow-up time of 328 ± 258 days (range 26 to 914 days).

Conclusions

For PAVMs with feeding artery diameters of 2 to 7.9 mm (mean 3.3 ± 1.2 mm), MVP™ systems are safe and effective given their high technical success rates and lack of persistence. Further prospective work will be required to elucidate the advantages and disadvantages of these MVP™ systems for PAVM embolization.

Level of Evidence

Level III.
Literature
1.
go back to reference Garg N, Khunger M, Gupta A, Kumar N. Optimal management of hereditary hemorrhagic telangiectasia. J Blood Med. 2014;5:191–206.PubMedPubMedCentral Garg N, Khunger M, Gupta A, Kumar N. Optimal management of hereditary hemorrhagic telangiectasia. J Blood Med. 2014;5:191–206.PubMedPubMedCentral
2.
go back to reference Pollak JS, Saluja S, Thabet A, et al. Clinical and anatomic outcomes after embolotherapy of pulmonary arteriovenous malformations. J Vasc Interv Radiol. 2006;17(1):35–44.CrossRefPubMed Pollak JS, Saluja S, Thabet A, et al. Clinical and anatomic outcomes after embolotherapy of pulmonary arteriovenous malformations. J Vasc Interv Radiol. 2006;17(1):35–44.CrossRefPubMed
3.
go back to reference Andersen PE, Kjeldsen AD. Embolization of pulmonary AVMs of feeding arteries less than 3 mm: reports of two cases and an 8-year follow-up without embolization. Acta Radiol Short Rep 2012;1(2):1–5.CrossRef Andersen PE, Kjeldsen AD. Embolization of pulmonary AVMs of feeding arteries less than 3 mm: reports of two cases and an 8-year follow-up without embolization. Acta Radiol Short Rep 2012;1(2):1–5.CrossRef
4.
5.
go back to reference Faughnan ME, Palda VA, Garcia-Tsao G, et al. International guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia. J Med Genet. 2011;48(2):73–87.CrossRefPubMed Faughnan ME, Palda VA, Garcia-Tsao G, et al. International guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia. J Med Genet. 2011;48(2):73–87.CrossRefPubMed
6.
go back to reference Letourneau-Guillon L, Faughnan ME, Soulez G, et al. Embolization of pulmonary arteriovenous malformations with amplatzer vascular plugs: safety and midterm effectiveness. J Vasc Interv Radiol. 2010;21(5):649–56.CrossRefPubMed Letourneau-Guillon L, Faughnan ME, Soulez G, et al. Embolization of pulmonary arteriovenous malformations with amplatzer vascular plugs: safety and midterm effectiveness. J Vasc Interv Radiol. 2010;21(5):649–56.CrossRefPubMed
7.
go back to reference Hsu CC, Kwan GN, Thompson SA, et al. Embolisation for pulmonary arteriovenous malformation. Cochrane Database Syst Rev. 2015;1:CD008017.PubMed Hsu CC, Kwan GN, Thompson SA, et al. Embolisation for pulmonary arteriovenous malformation. Cochrane Database Syst Rev. 2015;1:CD008017.PubMed
8.
go back to reference Hsu CC, Kwan GN, Thompson SA, van Driel ML. Embolisation therapy for pulmonary arteriovenous malformations. Cochrane Database Syst Rev. 2010;5:CD008017. Hsu CC, Kwan GN, Thompson SA, van Driel ML. Embolisation therapy for pulmonary arteriovenous malformations. Cochrane Database Syst Rev. 2010;5:CD008017.
9.
go back to reference Milic A, Chan RP, Cohen JH, Faughnan ME. Reperfusion of pulmonary arteriovenous malformations after embolotherapy. J Vasc Interv Radiol. 2005;16(12):1675–83.CrossRefPubMed Milic A, Chan RP, Cohen JH, Faughnan ME. Reperfusion of pulmonary arteriovenous malformations after embolotherapy. J Vasc Interv Radiol. 2005;16(12):1675–83.CrossRefPubMed
10.
go back to reference Shimohira M, Kawai T, Hashizume T, et al. Reperfusion rates of pulmonary arteriovenous malformations after coil embolization: evaluation with time-resolved MR angiography or pulmonary angiography. J Vasc Interv Radiol. 2015;26(6):856–64.CrossRefPubMed Shimohira M, Kawai T, Hashizume T, et al. Reperfusion rates of pulmonary arteriovenous malformations after coil embolization: evaluation with time-resolved MR angiography or pulmonary angiography. J Vasc Interv Radiol. 2015;26(6):856–64.CrossRefPubMed
11.
go back to reference Trerotola SO, Pyeritz RE. Does use of coils in addition to amplatzer vascular plugs prevent recanalization? AJR Am J Roentgenol. 2010;195(3):766–71.CrossRefPubMed Trerotola SO, Pyeritz RE. Does use of coils in addition to amplatzer vascular plugs prevent recanalization? AJR Am J Roentgenol. 2010;195(3):766–71.CrossRefPubMed
12.
go back to reference Fidelman N, Gordon RL, Bloom AI, et al. Reperfusion of pulmonary arteriovenous malformations after successful embolotherapy with vascular plugs. J Vasc Interv Radiol. 2008;19(8):1246–50.CrossRefPubMed Fidelman N, Gordon RL, Bloom AI, et al. Reperfusion of pulmonary arteriovenous malformations after successful embolotherapy with vascular plugs. J Vasc Interv Radiol. 2008;19(8):1246–50.CrossRefPubMed
13.
go back to reference Rabellino M, Serra M, Peralta O, et al. Early experience with the AMPLATZER vascular plug IV for the occlusion of pulmonary arteriovenous malformations. J Vasc Interv Radiol. 2014;25(9):1333–7.CrossRefPubMed Rabellino M, Serra M, Peralta O, et al. Early experience with the AMPLATZER vascular plug IV for the occlusion of pulmonary arteriovenous malformations. J Vasc Interv Radiol. 2014;25(9):1333–7.CrossRefPubMed
14.
go back to reference Wang W, Li H, Tam MD, et al. The amplatzer vascular plug: a review of the device and its clinical applications. Cardiovasc Intervent Radiol. 2012;35(4):725–40.CrossRefPubMed Wang W, Li H, Tam MD, et al. The amplatzer vascular plug: a review of the device and its clinical applications. Cardiovasc Intervent Radiol. 2012;35(4):725–40.CrossRefPubMed
15.
go back to reference Rossi M, Rebonato A, Greco L, et al. A new device for vascular embolization: report on case of two pulmonary arteriovenous fistulas embolization using the amplatzer vascular plug. Cardiovasc Intervent Radiol. 2006;29(5):902–6.CrossRefPubMed Rossi M, Rebonato A, Greco L, et al. A new device for vascular embolization: report on case of two pulmonary arteriovenous fistulas embolization using the amplatzer vascular plug. Cardiovasc Intervent Radiol. 2006;29(5):902–6.CrossRefPubMed
16.
go back to reference Pellerin O, Maleux G, Dean C, et al. Microvascular plug: a new embolic material for hepatic arterial skeletonization. Cardiovasc Intervent Radiol. 2014;37(6):1597–601.CrossRefPubMed Pellerin O, Maleux G, Dean C, et al. Microvascular plug: a new embolic material for hepatic arterial skeletonization. Cardiovasc Intervent Radiol. 2014;37(6):1597–601.CrossRefPubMed
17.
go back to reference Barrett L, Brown NI, Joseph VP. First use of Micro Vascular Plugs in Australia: endovascular treatment of pulmonary arteriovenous malformation. J Med Imaging Radiat Oncol. 2018;62(1):72–6.CrossRefPubMed Barrett L, Brown NI, Joseph VP. First use of Micro Vascular Plugs in Australia: endovascular treatment of pulmonary arteriovenous malformation. J Med Imaging Radiat Oncol. 2018;62(1):72–6.CrossRefPubMed
18.
go back to reference Beaty NB, Jindal G, Gandhi D. Micro Vascular Plug (MVP)-assisted vessel occlusion in neurovascular pathologies: technical results and initial clinical experience. J Neurointerv Surg. 2015;7(10):758–61.CrossRefPubMed Beaty NB, Jindal G, Gandhi D. Micro Vascular Plug (MVP)-assisted vessel occlusion in neurovascular pathologies: technical results and initial clinical experience. J Neurointerv Surg. 2015;7(10):758–61.CrossRefPubMed
19.
go back to reference Conrad MB, Ishaque BM, Surman AM, et al. Intraprocedural safety and technical success of the MVP micro vascular plug for embolization of pulmonary arteriovenous malformations. J Vasc Interv Radiol. 2015;26(11):1735–9.CrossRefPubMed Conrad MB, Ishaque BM, Surman AM, et al. Intraprocedural safety and technical success of the MVP micro vascular plug for embolization of pulmonary arteriovenous malformations. J Vasc Interv Radiol. 2015;26(11):1735–9.CrossRefPubMed
20.
go back to reference Boatta E, Jahn C, Canuet M, et al. Pulmonary arteriovenous malformations embolized using a micro vascular plug system: technical note on a preliminary experience. Cardiovasc Intervent Radiol. 2017;40(2):296–301.CrossRefPubMed Boatta E, Jahn C, Canuet M, et al. Pulmonary arteriovenous malformations embolized using a micro vascular plug system: technical note on a preliminary experience. Cardiovasc Intervent Radiol. 2017;40(2):296–301.CrossRefPubMed
21.
go back to reference Woodward CS, Pyeritz RE, Chittams JL, Trerotola SO. Treated pulmonary arteriovenous malformations: patterns of persistence and associated retreatment success. Radiology. 2013;269(3):919–26.CrossRefPubMed Woodward CS, Pyeritz RE, Chittams JL, Trerotola SO. Treated pulmonary arteriovenous malformations: patterns of persistence and associated retreatment success. Radiology. 2013;269(3):919–26.CrossRefPubMed
22.
go back to reference Yasumoto T, Osuga K, Yamamoto H, et al. Long-term outcomes of coil packing for visceral aneurysms: correlation between packing density and incidence of coil compaction or recanalization. J Vasc Interv Radiol. 2013;24(12):1798–807.CrossRefPubMed Yasumoto T, Osuga K, Yamamoto H, et al. Long-term outcomes of coil packing for visceral aneurysms: correlation between packing density and incidence of coil compaction or recanalization. J Vasc Interv Radiol. 2013;24(12):1798–807.CrossRefPubMed
23.
go back to reference Greben CR, Setton A, Putterman D, et al. Pulmonary arteriovenous malformation embolization: how we do it. Tech Vasc Interv Radiol. 2013;16(1):39–44.CrossRefPubMed Greben CR, Setton A, Putterman D, et al. Pulmonary arteriovenous malformation embolization: how we do it. Tech Vasc Interv Radiol. 2013;16(1):39–44.CrossRefPubMed
24.
go back to reference Abdel Aal AK, Massoud MO, Elantably DM. Does the type and size of Amplatzer vascular plug affect the occlusion time of pulmonary arteriovenous malformations? Diagn Interv Radiol. 2017;23(1):61–5.CrossRefPubMed Abdel Aal AK, Massoud MO, Elantably DM. Does the type and size of Amplatzer vascular plug affect the occlusion time of pulmonary arteriovenous malformations? Diagn Interv Radiol. 2017;23(1):61–5.CrossRefPubMed
26.
go back to reference Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol. 2003;14:S199–202.CrossRef Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol. 2003;14:S199–202.CrossRef
Metadata
Title
MVP™ Micro Vascular Plug Systems for the Treatment of Pulmonary Arteriovenous Malformations
Authors
Christopher R. Bailey
Anirudh Arun
Matthew Towsley
Won Kyu Choi
Joshua F. Betz
Stacey MacKenzie
Moustafa Abou Areda
Madhavi Duvvuri
Sally Mitchell
Clifford R. Weiss
Publication date
01-03-2019
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 3/2019
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-018-2106-x

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