Fatal pulmonary embolism of polyvinyl alcohol particles following therapeutic embolisation of a peripheral arteriovenous malformation

Summary

Embolotherapy of arteriovenous malformations (AVM) is not without risk. A 28-year-old woman underwent transcatheter selective embolisation of an AVM in the cheek using polyvinyl alcohol (PVA) microparticles. She became hypoxic and hypotensive post procedure, and had repeated cardiorespiratory arrests despite aggressive support. Resistant hypoxia with gross right heart dilatation on echocardiography suggested extensive pulmonary embolism. She died 24 h later. A postmortem confirmed widespread thrombosis and PVA particles in the pulmonary microvasculature identical to that in the treated AVM. This is the first reported death from PVA particle pulmonary embolism following therapeutic embolisation of a peripheral AVM.