Feeding-Artery Microvascular Plug Embolization Versus Nidus-Plus-Feeding-Artery Coil Embolization of Pulmonary Arteriovenous Malformations

<b>Background/Objectives</b>: Microvascular plug embolization in the distal feeding artery (FA-MVP) and coil embolization targeting the nidus and feeding artery (NiFA-coil) are effective treatments for pulmonary arteriovenous malformations (PAVMs). This study compares their outcomes. <b>Methods</b>: A retrospective chart review was conducted on patients who underwent NiFA-coil or FA-MVP embolization for PAVMs between October 2014 and May 2024, with initial (short-term) follow-up chest CT imaging performed within 18 months, and the latest (long-term) follow-up performed at least 3 years post-treatment. Durable occlusion was defined as ≥70% shrinkage of the nidus or draining vein on follow-up CT. A Cox proportional hazards regression model assessed the association between technique and durable occlusion, with inverse propensity score weighting used to adjust for patient and PAVM characteristics. <b>Results</b>: A total of 142 PAVMs (48 FA-MVP, 94 NiFA-coil) in 85 patients were analyzed. Durable occlusion was 97.2% (138/142) at a median short-term follow-up of 4.2 months and 90.2% (37/41) at a median long-term follow-up of 56.0 months. Simple PAVMs were more frequent in the FA-MVP group (93.8%, 45/48) than in the NiFA-coil group (61.2%, 58/94) (<i>p</i> < 0.001). The NiFA-coil group had larger feeding arteries (3.8 mm vs. 2.3 mm, <i>p</i> < 0.001) and sac sizes (13.1 mm vs. 7.7 mm, <i>p</i> = 0.040). Short and long-term durable occlusion rates were comparable (NiFA-coil: 96.8% and 88.9%; FA-MVP: 97.8% and 92.9%, respectively; <i>p</i> > 0.99, <i>p</i> > 0.99). After propensity score matching, compared to FA-MVP, NiFA-coil had a hazard ratio for short-term persistence of 1.06 (95% CI, 0.16-6.99; <i>p</i> = 0.956). <b>Conclusions</b>: Both NiFA-coil and FA-MVP embolization are highly effective for PAVM treatment, with similar success rates.