Where is the Origin of the Last Normal Branch from Feeding Artery of Pulmonary Arteriovenous Malformations?

Abstract Purpose Reperfusion via pulmonary-to-pulmonary arterial anastomoses is known as one type of recurrence of pulmonary arteriovenous malformations (PAVMs) after embolization. It is important to occlude the fistulous portion beyond the origin of the last normal branch from feeding artery of PAVMs to prevent recurrence. In this study, we evaluate the origin of the last normal branch by CT as well as its visibility on pulmonary arteriography (PAG). Materials and Methods We reviewed forty patients with 77 PAVMs who underwent coil embolization between October 2007 and December 2017. All patients underwent MDCT before embolization. Axial and MPR CT lung images were reviewed with special interests in the origin of the last normal branch from feeding artery of PAVMs. The origin was classified into three portions, including sac, junction (portion just proximal to the sac) and proximal feeder (more than 5 mm proximal to the sac). We also evaluated whether PAG can depict the normal branches detected by MDCT. Results MDCT showed that the last normal branch originated from sac in 30 PAVMs (39.0%), junction in 39 (50.6%), and proximal feeder in 8 (10.4%).On selective PAG, the last normal branch could be visualized in 30 PAVMs (39.0%), although it could not be visualized due to high-flow shunt in the other 47 PAVMs. Conclusions Selective PAG frequently fails to demonstrate the last normal branch from feeding artery of PAVMs, which often originates from the sac. Pretherapeutic evaluation of CT images of the last normal branch is important to prevent reperfusion of PAVMs. Level of Evidence Level 3, local non-random sample.

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Correction To: Where is the Origin of the Last Normal Branch from Feeding Artery of Pulmonary Arteriovenous Malformations?

CardioVascular and Interventional Radiology ◽

10.1007/s00270-019-02281-y ◽

2019 ◽

Vol 42 (10) ◽

pp. 1510-1510

Author(s):

Miyuki Maruno ◽

Hiro Kiyosue ◽

Norio Hongo ◽

Shunro Matsumoto ◽

Hiromu Mori

Keyword(s):

Arteriovenous Malformations ◽

Pulmonary Arteriovenous Malformations ◽

Feeding Artery ◽

Normal Branch

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Occlusion of pulmonary arteriovenous malformations by use of vascular plug

Acta Radiologica ◽

10.1080/02841850701280866 ◽

2007 ◽

Vol 48 (5) ◽

pp. 496-499 ◽

Cited By ~ 14

Author(s):

P. E. Andersen ◽

A. D. Kjeldsen

Keyword(s):

Arteriovenous Malformations ◽

High Flow ◽

Amplatzer Vascular Plug ◽

Pulmonary Arteriovenous Malformations ◽

Vascular Plug ◽

New Device ◽

Cerebral Complications

Pulmonary arteriovenous malformations are commonly treated by embolization with coils or balloons to prevent cerebral complications and to raise the oxygenation of the blood. The Amplatzer vascular plug is a new occlusive device made of a self-expanding cylindrical nitinol mesh. It is fast and safe to position, and can be repositioned before final delivery. It is especially suited for embolization of large high-flow vessels as in pulmonary arteriovenous malformations with big feeding arteries. Two cases of successful use of the new device for treatment of large pulmonary arteriovenous malformations are described.

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Approach to Pulmonary Arteriovenous Malformations: A Comprehensive Update

Journal of Clinical Medicine ◽

10.3390/jcm9061927 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1927 ◽

Cited By ~ 4

Author(s):

Shamaita Majumdar ◽

Justin P. McWilliams

Keyword(s):

Chest Pain ◽

Hereditary Hemorrhagic Telangiectasia ◽

Gold Standard ◽

Arteriovenous Malformations ◽

Pulmonary Arteries ◽

Clinical Manifestations ◽

High Flow ◽

Pulmonary Arteriovenous Malformations ◽

Institutional Experience ◽

Arteries And Veins

Pulmonary arteriovenous malformations (PAVMs) are abnormal direct vascular communications between pulmonary arteries and veins which create high-flow right-to-left shunts. They are most frequently congenital, usually in the setting of hereditary hemorrhagic telangiectasia (HHT). PAVMs may be asymptomatic or present with a wide variety of clinical manifestations such as dyspnea, hypoxemia, or chest pain. Even when asymptomatic, presence of PAVMs increases patients’ risk of serious, potentially preventable complications including stroke or brain abscess. Transcatheter embolotherapy is considered the gold standard for treatment of PAVMs. Though previous guidelines have been published regarding the management of PAVMs, several aspects of PAVM screening and management remain debated among the experts, suggesting the need for thorough reexamination of the current literature. The authors of this review present an updated approach to the diagnostic workup and management of PAVMs, with an emphasis on areas of controversy, based on the latest literature and our institutional experience.

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The role of angiogenesis in the development of pulmonary arteriovenous malformations in children after cavopulmonary anastomosis

Cardiology in the Young ◽

10.1017/s1047951100004352 ◽

1997 ◽

Vol 7 (4) ◽

pp. 370-374 ◽

Cited By ~ 18

Author(s):

Blair Marshall ◽

Brian W. Duncan ◽

Richard A. Jonas

Keyword(s):

Arteriovenous Malformations ◽

Fontan Procedure ◽

Pulmonary Arteriovenous Malformations ◽

Arterial Circulation ◽

Clinical Observations ◽

Bidirectional Glenn Shunt ◽

Cavopulmonary Anastomosis ◽

Pulmonary Arterial ◽

End Stage

AbstractPulmonary arteriovenous malformations are a frequent cause of progressive cyanosis after construction of a cavopulmonary anastomosis. Their formation complicates the management of children with single ventricle physiology after a bidirectional Glenn shunt or the Kawashima procedure. The key role of the liver in this phenomenon is suggested by the observation that providing modifications of the Fontan procedure which permit hepatic venous effluent to reach the pulmonary arterial circulation limit further development of the malformations. In addition, it is known that patients with end-stage hepatic failure develop pulmonary arteriovenous malformations that diminish after liver transplantation. We have begun purification of a factor derived from hepatocyte-conditioned media that is inhibitory for the proliferation of cultured endothelial cells. This substance is heat sensitive, and binds avidly to a copper-containing chromatography column. These clinical observations, and this preliminary experimental work, support the concept that hepatic-derived angiogenic factors may play a role in the development of pulmonary arteriovenous malformations after construction of cavopulmonary anastomoses.

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