Faculty Collaboration Database

Smoking Significantly Impacts Persistence Rates in Embolized Pulmonary Arteriovenous Malformations in Patients with Hereditary Hemorrhagic Telangiectasia. Radiology 2019 Sep;292(3):762-770

Date

07/31/2019

Pubmed ID

31361208

Pubmed Central ID

PMC6735354

DOI

10.1148/radiol.2019180978

Scopus ID

2-s2.0-85071497022 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

Background Embolization is the standard of care for treatment of pulmonary arteriovenous malformations (PAVMs). Persistence of PAVMs after embolization occurs for undefined reasons but may include inflammation related to smoking in dysregulated angiogenesis. Purpose To determine whether patients with hereditary hemorrhagic telangiectasia (HHT) who smoke tobacco are more prone to PAVM persistence after embolization. Materials and Methods Patients with HHT treated for PAVMs between January 2000 and August 2017 were retrospectively identified. Only PAVMs with no previous treatment and patients with both clinical and imaging follow-up were included. Age, sex, PAVM characteristics (size, complexity, and location), embolization material used, microcatheter type, smoking history, active tobacco use, and other risk factors for arterial disease were analyzed by using a multivariate Cox proportional hazards model to determine risk factors for persistence. Results Five-year persistence-free survival rates in nonsmokers, smokers of 1-20 pack-years, and smokers of more than 20 pack-years were 12.2%, 21.9%, and 37.4% respectively. Smokers with more than 20 pack-years relative to nonsmokers had greater risk of persistence after adjusting for arterial feeder size (hazard ratio, 3.8; 95% confidence interval [CI]: 1.5, 10.0; P = .007). Patients who reported active tobacco use at the time of PAVM embolization had a 5-year cumulative incidence of persistence of 26.3% compared with 13.5% in inactive smokers. After adjusting for arterial feeder size, the risk of persistence was greater in tobacco users versus inactive smokers at the time of treatment (hazard ratio, 2.4; 95% CI: 1.2, 4.7; P = .01). Conclusion Smoking is associated with pulmonary arteriovenous malformation persistence after embolization in patients with hereditary hemorrhagic telangiectasia. Online supplemental material is available for this article. See also the editorial by Trerotola and Pyeritz in this issue.

Author List

Haddad MM, Bendel EC, Harmsen WS, Iyer VN, Misra S

Author

Mustafa Haddad MD Assistant Professor in the Radiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Arteriovenous Fistula
Child
Comorbidity
Embolization, Therapeutic
Female
Humans
Incidence
Male
Middle Aged
Pulmonary Artery
Pulmonary Veins
Retrospective Studies
Risk Factors
Smoking
Survival Analysis
Telangiectasia, Hereditary Hemorrhagic
Young Adult