Meticulous observations essential before and after coil embolization of pulmonary arteriovenous malformation; lessons learned from two case

Abstract

BACKGROUND: Endovascular coil embolization is an approved treatment for pulmonary arteriovenous malformation (AVM) but it brings high rate of thromboembolic complications with subsequent morbidity and mortality. Hereby, we report two cases of AVM coil embolization and management of their compilations. CASE REPORT: The first case was a 57-year-old male with five implanted coils in the lower lobe of right lung in which two of them were migrated soon after implantation. On exploration, a large atrial septal defect was detected and then repaired successfully. The next day, he was transferred for fluoroscopy. Two embolized coils were found at the site of the left iliac artery which was extracted via snare through sheath implanted in the left femoral artery. Coil migration to the left atrium and subsequently to the left iliac artery is reported for the first time. The second case was a 45-year-old male with central cyanosis and clubbing of upper and lower extremities from childhood. On computed tomography angiography (CTA), a vascular lesion was found. The patient underwent coil embolization for closure of AVM. The patient was still symptomatic after successful closure of AVM. On CTA, two feeding arteries were detected. He underwent second coil embolization procedure. CONCLUSION: AVM coil embolization is a temptative procedure, which should be performed on its real indications by an expert centers who can handle complications of this procedure. The performance of CTA seems beneficial in some cases to confirm complete embolization of AVM.