Comparison of the application of coils and vascular plug in interventional embolization therapy for simple pulmonary arteriovenous malformations_West China Medical Journal

Authors：

NIE Weishan , GUO Li , WU Hongxia , WANG Ye ,  JIANG Faming ,  LIANG Zong’an

Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

JIANG Faming, Email: jiangfam@163.com; LIANG Zong’an, Email: liangza@scu.edu.cn

Keywords：

Pulmonary arteriovenous malformation; embolization; coils; vascular plug

DOI：

10.7507/1002-0179.202512107

Video：

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Objective To explore the application effects of coils and vascular plug in the interventional embolization treatment of simple pulmonary arteriovenous malformation (PAVM) in the Chinese real-world setting, and compare the persistent occlusion effect and cost-effectiveness of the two types of devices. Methods Simple PAVM patients who underwent interventional embolization at the Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University between January 1, 2020 and August 30, 2025 were selected retrospectively. The included patients were divided into the coil group and the vascular occlusion device/combination group according to the type of embolization instrument used in the interventional surgery. Clinical, imaging, procedural, and follow-up data were collected. The primary unit of analysis was PAVM. Primary outcome is durable occlusion rate and recanalization/persistence rate, assessed by strict imaging criteria. Intergroup comparisons, Kaplan-Meier survival analysis, and logistic regression were performed to compare treatment outcomes between coils and vascular plugs and to explore risk factors for persistence. Cost analysis was conducted to compare the cumulative cost required to achieve durable occlusion for each device. Results A total of 34 PAVM in 29 patients were included. The persistence rate was significantly lower in the vascular plug/combination group compared to the coil group (0.0% vs. 47.8%, P=0.006). The vascular plug group demonstrated higher durable occlusion rates at ≥12 months (100.0% vs. 60.9%, P=0.017), along with a significantly longer duration of sustained occlusion (P=0.008). Multivariate logistic regression analysis did not identify independent predictive factors, although the distance from the embolic device to the sac entrance showed a borderline significant association (P=0.080). The cost analysis results showed that although the surgical instrument cost, total material cost, total surgical cost of the vascular occlusion device/combination group were higher (P<0.001). There was no statistically significant difference in the cumulative total cost between the two groups (P=0.066). Conclusions For the treatment of simple PAVM, vascular plugs provide significantly superior long-term occlusion outcomes compared to coils. From a long-term perspective, the advantage of vascular plugs in reducing the need for re-intervention, their overall cost-effectiveness is expected to become more prominent, demonstrating superior value for clinical application and health economics.

Citation： NIE Weishan, GUO Li, WU Hongxia, WANG Ye, JIANG Faming, LIANG Zong’an. Comparison of the application of coils and vascular plug in interventional embolization therapy for simple pulmonary arteriovenous malformations. West China Medical Journal, 2026, 41(1): 12-18. doi: 10.7507/1002-0179.202512107 Copy

1.	Mager JJ, Overtoom TTC, Blauw H, et al. Embolotherapy of pulmonary arteriovenous malformations: long-term results in 112 patients. J Vasc Interv Radiol, 2004, 15(5): 451-456.
2.	Majumdar S, McWilliams JP. Approach to pulmonary arteriovenous malformations: a comprehensive update. J Clin Med, 2020, 9(6): 1927.
3.	Trerotola SO, Pyeritz RE. PAVM embolization: an update. AJR Am J Roentgenol, 2010, 195(4): 837-845.
4.	Hundt W, Kalinowski M, Kiessling A, et al. Novel approach to complex pulmonary arteriovenous malformation embolization using detachable coils and Amplatzer vascular plugs. Eur J Radiol, 2012, 81(5): 732-738.
5.	Woodward CS, Pyeritz RE, Chittams JL, et al. Treated pulmonary arteriovenous malformations: patterns of persistence and associated re treatment success. Radiology, 2013, 269(3): 919-926.
6.	Fohlen A, Namur J, Ghegediban SH, et al. Midterm recanalization after arterial embolization using hydrogel-coated coils versus fibered coils in an animal model. J Vasc Interv Radiol, 2019, 30(6): 940-948.
7.	Tau N, Atar E, Mei-Zahav M, et al. Amplatzer vascular plugs versus coils for embolization of pulmonary arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia. Cardiovasc Intervent Radiol, 2016, 39(8): 1110-1114.
8.	Ratnani R, Sutphin PD, Koshti V, et al. Retrospective comparison of pulmonary arteriovenous malformation embolization with the polytetrafluoroethylene-covered nitinol microvascular plug, AMPLATZER Plug, and coils in patients with hereditary hemorrhagic telangiectasia. J Vasc Interv Radiol, 2019, 30(7): 1089-1097.
9.	Latif MA, Bailey CR, Motaghi M, et al. Postembolization persistence of pulmonary arteriovenous malformations:a retrospective comparison of coils and Amplatzer and micro vascular plugs using propensity score weighting. AJR AmJ Roentgenol, 2023, 220(1): 95-103.
10.	Botsford A, Tradi F, Loubet A, et al. Transarterial embolization of simple pulmonary arteriovenous malformations: long-term outcomes of 0. 018-inch coils versus vascular plugs. J Vasc Interv Radiol, 2024, 35(3): 349-360.
11.	Kucukay F, ?zdemir M, ?enol E, et al. Large pulmonary arteriovenous malformations: long-term results of embolization with AMPLATZER vascular plugs. J Vasc Interv Radiol, 2014, 25(9): 1327-1332.
12.	Cha JG, Park J, Park B, et al. Single-center 10-year retrospective analysis of Amplatzer vascular plug 4 embolization for pulmonary arteriovenous malformations with feeding arteries of <6 mm. Diagn Interv Radiol, 2025, 31(2): 152-160.
13.	Tapping CR, Ettles DF, Robinson GJ, et al. Long-term follow-up of treatment of pulmonary arteriovenous malformations with Amplatzer vascular plug and Amplatzer vascular plug II devices.J Vasc Interv Radiol, 2011, 22(12): 1740-1746.
14.	Abdel Aal AK, Hamed MF, Biosca RF, et al. Occlusion time for Amplatzer vascular plug in the management of pulmonary arteriovenous malformations. AJR Am J Roentgenol, 2009, 192(3): 793-799.
15.	Stein EJ, Chittams JL, Miller M, et al. Persistence in coil-embolized pulmonary arteriovenous malformations with feeding artery diameters of 3 mm or less: a retrospective single-center observational study. J Vasc Interv Radiol, 2017, 28(3): 442-449.
16.	Milic A, Chan RP, Cohen JH, et al. Persistence of pulmonary arteriovenous malformations after embolotherapy. J Vasc Interv Radiol, 2005, 16(12): 1675-1683.
17.	Lee DW, White RI Jr, Egglin TK, et al. Embolotherapy of large pulmonary arteriovenous malformations: long-term results. Ann Thorac Surg, 1997, 64(4): 930-939.
18.	Prasad V, Chan RP, Faughnan ME. Embolotherapy of pulmonary arteriovenous malformations: efficacy of platinum versus stainless steel coils. J Vasc Interv Radiol, 2004, 15(2 Pt 1): 153-160.
19.	Remy-Jardin M, Dumont P, Brillet PY, et al. Pulmonary arteriovenous malformations treated with embolotherapy: helical CT evaluation of long-term effectiveness after 2-21-year follow-up. Radiology, 2006, 239(2): 576-585.
20.	Faughnan ME, Palda VA, Garcia-Tsao G, et al. International guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia. J Med Genet, 2011, 48(2): 73-87.
21.	Akaike H. A new look at the statistical model identification. IEEE Trans Automat Contr, 1974, 19(6): 716-723.

1. Mager JJ, Overtoom TTC, Blauw H, et al. Embolotherapy of pulmonary arteriovenous malformations: long-term results in 112 patients. J Vasc Interv Radiol, 2004, 15(5): 451-456.
2. Majumdar S, McWilliams JP. Approach to pulmonary arteriovenous malformations: a comprehensive update. J Clin Med, 2020, 9(6): 1927.
3. Trerotola SO, Pyeritz RE. PAVM embolization: an update. AJR Am J Roentgenol, 2010, 195(4): 837-845.
4. Hundt W, Kalinowski M, Kiessling A, et al. Novel approach to complex pulmonary arteriovenous malformation embolization using detachable coils and Amplatzer vascular plugs. Eur J Radiol, 2012, 81(5): 732-738.
5. Woodward CS, Pyeritz RE, Chittams JL, et al. Treated pulmonary arteriovenous malformations: patterns of persistence and associated re treatment success. Radiology, 2013, 269(3): 919-926.
6. Fohlen A, Namur J, Ghegediban SH, et al. Midterm recanalization after arterial embolization using hydrogel-coated coils versus fibered coils in an animal model. J Vasc Interv Radiol, 2019, 30(6): 940-948.
7. Tau N, Atar E, Mei-Zahav M, et al. Amplatzer vascular plugs versus coils for embolization of pulmonary arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia. Cardiovasc Intervent Radiol, 2016, 39(8): 1110-1114.
8. Ratnani R, Sutphin PD, Koshti V, et al. Retrospective comparison of pulmonary arteriovenous malformation embolization with the polytetrafluoroethylene-covered nitinol microvascular plug, AMPLATZER Plug, and coils in patients with hereditary hemorrhagic telangiectasia. J Vasc Interv Radiol, 2019, 30(7): 1089-1097.
9. Latif MA, Bailey CR, Motaghi M, et al. Postembolization persistence of pulmonary arteriovenous malformations:a retrospective comparison of coils and Amplatzer and micro vascular plugs using propensity score weighting. AJR AmJ Roentgenol, 2023, 220(1): 95-103.
10. Botsford A, Tradi F, Loubet A, et al. Transarterial embolization of simple pulmonary arteriovenous malformations: long-term outcomes of 0. 018-inch coils versus vascular plugs. J Vasc Interv Radiol, 2024, 35(3): 349-360.
11. Kucukay F, ?zdemir M, ?enol E, et al. Large pulmonary arteriovenous malformations: long-term results of embolization with AMPLATZER vascular plugs. J Vasc Interv Radiol, 2014, 25(9): 1327-1332.
12. Cha JG, Park J, Park B, et al. Single-center 10-year retrospective analysis of Amplatzer vascular plug 4 embolization for pulmonary arteriovenous malformations with feeding arteries of <6 mm. Diagn Interv Radiol, 2025, 31(2): 152-160.
13. Tapping CR, Ettles DF, Robinson GJ, et al. Long-term follow-up of treatment of pulmonary arteriovenous malformations with Amplatzer vascular plug and Amplatzer vascular plug II devices.J Vasc Interv Radiol, 2011, 22(12): 1740-1746.
14. Abdel Aal AK, Hamed MF, Biosca RF, et al. Occlusion time for Amplatzer vascular plug in the management of pulmonary arteriovenous malformations. AJR Am J Roentgenol, 2009, 192(3): 793-799.
15. Stein EJ, Chittams JL, Miller M, et al. Persistence in coil-embolized pulmonary arteriovenous malformations with feeding artery diameters of 3 mm or less: a retrospective single-center observational study. J Vasc Interv Radiol, 2017, 28(3): 442-449.
16. Milic A, Chan RP, Cohen JH, et al. Persistence of pulmonary arteriovenous malformations after embolotherapy. J Vasc Interv Radiol, 2005, 16(12): 1675-1683.
17. Lee DW, White RI Jr, Egglin TK, et al. Embolotherapy of large pulmonary arteriovenous malformations: long-term results. Ann Thorac Surg, 1997, 64(4): 930-939.
18. Prasad V, Chan RP, Faughnan ME. Embolotherapy of pulmonary arteriovenous malformations: efficacy of platinum versus stainless steel coils. J Vasc Interv Radiol, 2004, 15(2 Pt 1): 153-160.
19. Remy-Jardin M, Dumont P, Brillet PY, et al. Pulmonary arteriovenous malformations treated with embolotherapy: helical CT evaluation of long-term effectiveness after 2-21-year follow-up. Radiology, 2006, 239(2): 576-585.
20. Faughnan ME, Palda VA, Garcia-Tsao G, et al. International guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia. J Med Genet, 2011, 48(2): 73-87.
21. Akaike H. A new look at the statistical model identification. IEEE Trans Automat Contr, 1974, 19(6): 716-723.

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