Interventional Management of Pulmonary Arteriovenous Malformations: Imaging Primer

Pulmonary arteriovenous malformations (PAVMs) are abnormal connections between the pulmonary arteries and veins, bypassing the capillary network and exposing patients to serious complications such as stroke, brain abscess, and hemothorax. The estimated prevalence of PAVMs is approximately one in 2630 individuals, with hereditary hemorrhagic telangiectasia accounting for over 80% of cases. PAVMs are classified as simple, complex, or diffuse based on their angioarchitecture. Diagnostic evaluation involves transthoracic contrast-enhanced echocardiography for screening, chest CT for confirmation, and pulmonary angiography primarily for guiding embolization. Endovascular embolization is the preferred treatment and is typically performed with vascular plugs, although coils may be required for small or tortuous vessels. Postprocedural follow-up with CT is essential to detect persistent or new PAVMs. During pregnancy, PAVMs may enlarge and rupture, significantly increasing complication risks and necessitating close monitoring and treatment. Persistent PAVMs can develop after treatment due to four distinct mechanisms of reopening, each requiring a tailored management approach. The authors provide a comprehensive overview of PAVM angioarchitecture, step-by-step embolization techniques, and a comparative analysis of embolization devices, highlighting their advantages and limitations. Additionally, the authors also discuss follow-up protocols and strategies for managing persistent PAVMs, emphasizing the importance of early detection and timely intervention in preventing severe and potentially life-threatening complications. ^©RSNA, 2025 Supplemental material is available for this article.