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Smoking Significantly Impacts Persistence Rates in Embolized Pulmonary Arteriovenous Malformations in Patients with Hereditary Hemorrhagic Telangiectasia.

Authors
  • Haddad, Mustafa M1
  • Bendel, Emily C1
  • Harmsen, William S1
  • Iyer, Vivek N1
  • Misra, Sanjay1
  • 1 From the Department of Radiology (M.M.H., E.C.B., S.M.), Department of Biomedical Statistics and Informatics (W.S.H.), and Department of Pulmonary and Critical Care Medicine (V.N.I.), Mayo Clinic, 200 First St SW, Rochester, MN 55905.
Type
Published Article
Journal
Radiology
Publisher
Radiological Society of North America
Publication Date
Sep 01, 2019
Volume
292
Issue
3
Pages
762–770
Identifiers
DOI: 10.1148/radiol.2019180978
PMID: 31361208
Source
Medline
Language
English
License
Unknown

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.

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