Smoking significantly impacts persistence rates in embolized pulmonary arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia

Mustafa M. Haddad, Emily C. Bendel, William S. Harmsen, Vivek N. Iyer, Sanjay Misra

Research output: Contribution to journalArticle

1 Citation (Scopus)

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 packyears 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.

Original languageEnglish (US)
Pages (from-to)762-770
Number of pages9
JournalRadiology
Volume292
Issue number3
DOIs
StatePublished - Jan 1 2019

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Hereditary Hemorrhagic Telangiectasia
Arteriovenous Malformations
Smoking
Lung
Tobacco Use
Tobacco
Confidence Intervals
Standard of Care
Proportional Hazards Models
Smoke
Therapeutics
Survival Rate
History
Inflammation
Incidence

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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Smoking significantly impacts persistence rates in embolized pulmonary arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia. / Haddad, Mustafa M.; Bendel, Emily C.; Harmsen, William S.; Iyer, Vivek N.; Misra, Sanjay.

In: Radiology, Vol. 292, No. 3, 01.01.2019, p. 762-770.

Research output: Contribution to journalArticle

Haddad, Mustafa M. ; Bendel, Emily C. ; Harmsen, William S. ; Iyer, Vivek N. ; Misra, Sanjay. / Smoking significantly impacts persistence rates in embolized pulmonary arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia. In: Radiology. 2019 ; Vol. 292, No. 3. pp. 762-770.
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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 packyears 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.",
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T1 - Smoking significantly impacts persistence rates in embolized pulmonary arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia

AU - Haddad, Mustafa M.

AU - Bendel, Emily C.

AU - Harmsen, William S.

AU - Iyer, Vivek N.

AU - Misra, Sanjay

PY - 2019/1/1

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N2 - 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 packyears 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.

AB - 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 packyears 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.

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