PMC6319526_01
a Baseline pulmonary digital subtraction angiography in a 52-year-old woman, affected by HHT, with several small PAVMs. b The biggest of these was located in the left lower lobe, with a feeding artery of 3 mm
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Fig1
The left pulmonary artery was catheterised, and angiography depicted the PAVM (Fig. 1a, b).
a After coil deployment, there was still flow in PAVM. b and c An additional MVP-3Q was deployed, and the flow stopped immediately
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Fig2
It was decided to deploy an MVP-3Q (Reverse Medical Corporation, Irvine CA, USA) through a 2.4 Fr microcatheter (Renegade microcatheter, Boston ScientificMarlborough, MA, USA) with following immediate occlusion (Fig. 2a-c).
PMC6319526_02
a A 19-year-old woman with HHT. Small PAVM with feeding artery 3.2 mm in the right upper lobe. b Previous embolization with coils of complex PAVM in the same lobe
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Fig3
The right pulmonary artery was catheterized, and angiography depicted two PAVMs, one in a right upper lobe and one in the right lower lobe (Fig. 3a, b).
a Before deployment of MVP-5Q. b After deployment of MVP-5Q, immediate stop of flow
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Fig4
The PAVM located in the upper lobe was engaged coaxially with microcatheter 2.8 Fr (Renegade Hi-Flo; Boston ScientificMarlborough, MA, USA) and primarily embolized with MVP-5Q (Reverse Medical Corporation, Irvine CA, USA) with following immediate occlusion (Fig. 4 a, b).
PMC6319526_03
Non-contrast CT showed a simple PAVM in right upper lobe with feeding artery of 3, 3 mm in diameter
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Fig5
CE confirmed shunt grade II-III and non-contrast CT showed two PAVMs, one located in the right lower lobe with feeding artery of 5 mm and the other with feeding artery of 3.3 mm in diameter located in the right upper lobe (Fig. 5).
Pulmonary angiography before and after embolization of both PAVMs in the right lung. The PAVM in upper lobe was embolized with MVP-5Q
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Fig6
The PAVM in the upper lobe was embolized with MPV-5Q (Reverse Medical Corporation, Irvine CA, USA) delivered through a microcatheter 2.8 Fr (Renegade Hi-Flo; Boston ScientificMarlborough, MA, USA) with following immediate occlusion of both PAVMs (Fig. 6 a, b).
PMC6319526_04
Pulmonary angiography before embolization of PAVMs in the right lung with two feeding arteries
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Fig7
The biggest had a feeding artery of 6 mm and was embolized with Amplatz plug IV (St Jude Medical, Minnesota, USA), 8 mm in diameter a few months before the actual intervention (Fig. 7).
The PAVM in lower lobe was embolized with detachable coil and with MVP-5Q
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Fig8
The other feeding artery with a diameter of 3.4 mm was embolized with MVP-5Q delivered through a microcatheter 2.8 Fr (Renegade Hi-Flo; Boston ScientificMarlborough, MA, USA), but due to highly angulated feeding artery the MVP was displaced a little proximally and occluded the feeding artery a longer distance to the PAVM than intended (Fig. 8).