Emerging techniques and treatment outcomes in pulmonary arteriovenous malformations embolisation: a narrative review

Background: Pulmonary arteriovenous malformations (PAVMs) are abnormal vascular connections between the pulmonary arteries and veins, often leading to significant clinical complications. Embolisation has become the primary therapeutic modality for managing symptomatic PAVMs, with advancements in both technique and technology improving patient outcomes. Recent progress includes the introduction of precisely targeted embolisation techniques, such as cone-beam computed tomography (CBCT) guidance and three-dimensional imaging, enabling more accurate identification and treatment of complex, multiple, or peripheral lesions. Additionally, vascular plugs and microcoils have demonstrated superior performance in terms of lower recurrence rates and more complete occlusion of feeding vessels compared to traditional devices. The use of endovascular navigation systems has further enhanced procedural success. Aim: The objective of this review is to explore the latest innovations in embolisation therapies for PAVMs, emphasising emerging techniques, devices, and strategies that have refined treatment efficacy and safety. Methods: We performed a focused literature search to identify key publications relevant to current approaches in thoracic vascular imaging. Searches were conducted in PubMed and Embase using combinations of terms related to ‘thoracic imaging,’ ‘vascular,’ ‘Computed Tomography (CT) angiography,’ and ‘MRI.’ Additional articles were identified from reference lists of major reviews and landmark studies. Priority was given to publications from the past 10 years, with older key papers included when historically relevant. Selection was based on thematic relevance rather than formal criteria. Conclusions: Advancements in patient selection and pre-procedural planning, driven by enhanced imaging modalities such as CT pulmonary angiography (CTPA) and contrast-enhanced ultrasound, have led to improved outcomes and reduced complications. While the benefits of embolisation are well-documented, ongoing research continues to explore the long-term outcomes, including post-embolisation pulmonary function, recurrence rates, and quality of life improvements.