CLINICAL STUDY Large Pulmonary Arteriovenous Malformations: Long-Term Results of Embolization with AMPLATZER Vascular Plugs Fahrettin Kucukay, MD, Mustafa Özdemir, MD, Eyüp S ¸ enol, MD, Sarper Okten, MD, Melih Ereren, MD, and Adnan Karan, MD ABSTRACT Purpose: To analyze the long-term results of endovascular treatment of large pulmonary arteriovenous malformations (PAVMs) using the AMPLATZER vascular plug (AVP; AGA Medical Corp, Golden Valley, Minnesota). Materials and Methods: Between May 2007 and April 2011, 18 patients with 24 large PAVMs, defined as PAVMs that had a feeding artery with a diameter of Z 8 mm, were treated with AVP I or AVP II. A single AVP device was used for each PAVM. Aneurysmal sac diameters, sac perfusion, sac shrinkage, and complete resolution before and after the intervention were analyzed. Complete histories, laboratory values, physical examinations, and multidetector computed tomography images were reviewed. The mean occlusion time for AVP I and AVP II and the mean arterial oxygen saturation (SaO 2 ) before and after the intervention were compared. Results: The mean diameter of the feeding artery was 11.46 mm  2.18 (range, 8–13.3 mm). The mean occlusion time was 7.34 minutes  1.23 for AVP I and 6.25 minutes  1.12 for AVP II (P ¼ .11). The mean SaO 2 before and after the intervention was 63.71%  8.10% (range, 51%–76%) and 96.28%  0.49% (range, 96%–97%), respectively (P ¼ .045). No major periprocedural complications were observed. The mean follow-up duration was 36.33 months  10.63 (range, 28–56 mo). During the follow-up period, there were no persistent sac perfusions, migration of the AVPs, major complications, or recanalizations. Conclusions: Treatment of large PAVMs with AVPs is an effective method for obtaining excellent long-term results. Embolization of large feeding arteries can be accomplished with AVPs without major complications. ABBREVIATIONS AVP = AMPLATZER vascular plug, PAVM = pulmonary arteriovenous malformation, SaO 2 = arterial oxygen saturation Coil embolization has been used to treat pulmonary arteriovenous malformations (PAVMs) (1–4). At the present time, most PAVMs are treated with platinum coils, but the risk of paradoxical embolization is still controversial, particularly in cases involving high-flow malformations with large outflow vessels. In these PAVMs, especially PAVMs with short feeding arteries, venous sac embolization with or without feeding artery embolization is still under investigation (2–4). A few previous case reports concluded that surgical treatment still plays an important role in the management of such large, high-flow PAVMs with aneurysmal formation in a central location, whereas interventional embolization was considered inappropriate because of vessel diameter and length (5–7). Advances in medical technology have facilitated the use of the AMPLATZER vascular plug (AVP; AGA Medical Corp, Golden Valley, Minnesota) for emboliza- tion of PAVMs in which the feeding artery has a diameter to 15–16 mm and a length of o 20 mm. The main advantages of the AVP are its ability to be repositioned after final placement, before screw release, and fewer complications noted when used for emboliza- tion of large feeding arteries (8). Although there are previous reports of the endovascular treatment of PAVMs with AVPs, the long-term results are limited. To our knowledge, only one study discusses the long- term results of embolization of large PAVMs with a & SIR, 2014 J Vasc Interv Radiol 2014; XX:]]]–]]] http://dx.doi.org/10.1016/j.jvir.2014.01.031 None of the authors have identified a conflict of interest. From the Department of Radiology, Turkiye Yuksek Ihtisas Hospital, Sihhiye 06100 Ankara Turkey. Received September 6, 2013; final revision received January 26, 2014; accepted January 27, 2014. Address correspondence to F.K.; E-mail: fkucukay@hotmail.com