Successful coil embolization of 3 pulmonary arteriovenous malformations using a gadolinium contrast agent in a patient with severe iodine allergy: A case report

We report the first successful coil embolization using a gadolinium contrast agent (GCA) of 3 pulmonary arteriovenous malformations (PAVMs) in a patient with severe iodine allergy. The patient was a female in her 40s with hereditary hemorrhagic telangiectasia. The 3 PAVMs had sacs with diameters of up to 20 mm and pulmonary feeding arteries with diameters of up to 5 mm. The PAVMs were located in segment (S) 8 and S9 of the right lung, and S8 of the left lung. Embolization was planned after administration of steroids and antihistamines. However, the procedure was stopped because preoperative pulmonary arteriography using an iodine contrast agent caused pharyngeal itching, coughing, and decreased percutaneous oxygen saturation. Because surgical resection is highly invasive, embolization using a GCA was selected as an alternative treatment strategy. After obtaining approval from our hospital's ethical review board, embolization with a GCA was planned. Embolization was performed in 3 separate sessions. The catheter's position was monitored and adjusted under angiography with manual injection of a GCA and low-dose computed tomography (CT) using an interventional radiology-CT system. The GCA was visible on angiography and coil embolization of the PAVM sacs and feeding arteries was performed. A small amount of GCA was used (7‒9 mL). The patient experienced no allergic reactions during the procedure. Although there are many reports of endovascular treatment using GCA for dialysis shunt stenosis and cerebrovascular disease in patients with iodine allergy, this is the first report describing the use of GCA during PAVM embolization.