Diagnosis and endovascular management of pulmonary arteriovenous malformations

2021 ◽  
pp. 20200695
Author(s):  
Harshit Kramdhari ◽  
Jineesh Valakkada ◽  
Anoop Ayyappan
Keyword(s):  
Arteriovenous Malformations ◽  
Transcatheter Embolization ◽  
Pulmonary Haemorrhage ◽  
Pulmonary Arteriovenous Malformations ◽  
Current Standard ◽  
Management Options ◽  
Current Trends ◽  
Pulmonary Capillaries ◽  
Paradoxical Emboli ◽  
Feeding Vessels

Pulmonary arteriovenous malformations (PAVM) are abnormal communication of a branch of the pulmonary artery and pulmonary vein circumventing the intervening pulmonary capillaries. This results in a right-to-left (R-L) shunt and its related manifestations, which include hampered gas exchange leading to hypoxaemia, dyspnoea, paradoxical emboli leading to stroke, cerebral abscess, myocardial infarction and pulmonary haemorrhage due to rupture of the PAVM. Endovascular transcatheter embolization of the feeding vessels with coils or occlusion devices is the current standard care of treatment and preferred treatment modality. The articles aim to provide insights into the current trends in diagnosis, the current recommendations, approach and management options for patients with PAVM.

scholarly journals Evaluation of percutaneous transcatheter embolization for pulmonary arteriovenous malformations

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
ZhengZhong Wu ◽  
JunQing Lin ◽  
WeiZhu Yang ◽  
Na Jiang ◽  
Ning Huang ◽  
...  
Keyword(s):  
New York ◽  
Success Rate ◽  
Arteriovenous Malformations ◽  
Heart Association ◽  
Transcatheter Embolization ◽  
Pulmonary Arteriovenous Malformations ◽  
Technical Success ◽  
Arterial Blood Gas ◽  
Technical Success Rate ◽  
Arterial Blood

Abstract Background The purpose of this study was to assess the safety and efficacy of percutaneous transcatheter embolization (TCE) for the treatment of pulmonary arteriovenous malformations (PAVMs). Methods Forty-three consecutive patients (n = 17 males; n = 26 females) with 72 untreated PAVMs underwent coil and/or plug embolization between January 2010 and February 2018. The mean patient age was 42 ± 14 years (range 19–71 years). The median size of the feeding artery was 7.9 ± 2.9 mm (range 3.5–14.0 mm). The arterial blood gas level and cardiac function of all patients were analysed. The technical success rate, recanalization rate, and complications were evaluated. Computed tomography angiography (CTA) examinations were scheduled for 12 months after treatment and every 2–4 years thereafter. Results Twenty-five PAVMs were treated with coils alone, twenty-one were treated with plugs alone, and twenty-six were treated with both coils and plugs. The technical success rate was 100%. There were no complications during operation. However, one patient (2.3%) had pulmonary thrombosis and embolism post-operation. The patients’ pre-operative and post-operative PaO2 and SaO2 levels were significantly different (p < 0.01). A comparison of the New York Heart Association (NYHA) grade before and after embolization in all patients showed a significant decrease in the post-operative grade (p < 0.01). The 72 PAVMs were divided into three groups (coils only group [n = 25], plugs only group [n = 21], and coils/plugs combined group [n = 26]). After 12 months of follow-up, there were seven reperfusion PAVMs in the coil group, seven reperfusion PAVMs in the plug group, and 1 reperfusion PAVM in the combined group. There were significant differences between the two groups and the combined group. Conclusion Percutaneous TCE is safe and effective for the treatment of PAVMs. A combination of coils and vascular plugs may be useful for preventing recanalization after the embolization of PAVMs.

Transcatheter embolization of pulmonary arteriovenous malformations in Rendu-Osler-Weber disease

Respirology ◽  
1998 ◽  
Vol 3 (4) ◽  
pp. 277-280 ◽  
Author(s):  
Takanobu SHIOYA ◽  
Masa-Aki SANO ◽  
Manabu KAGAYA ◽  
Nobuaki ITO ◽  
Akiko WATANABE ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Transcatheter Embolization ◽  
Pulmonary Arteriovenous Malformations

scholarly journals Variable Presentations in Pulmonary Arteriovenous Malformation

2020 ◽  
Vol 8 (2) ◽  
pp. 1-8
Author(s):  
Nasir Ahmad Lone ◽  
Akshit Kumar ◽  
Waseem Ahmed Sheikh
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Arteriovenous Malformation ◽  
Arteriovenous Malformations ◽  
Clinical Symptoms ◽  
Case Series ◽  
Neurological Complications ◽  
Pulmonary Arteriovenous Malformations ◽  
Exertional Dyspnea ◽  
Paradoxical Emboli

Pulmonary arteriovenous malformations (PAVM) are a group of vascular anomalies of lung which present with variable clinical symptoms. Most patients with PAVM are asymptomatic but it can cause dyspnea on exertion, paradoxical emboli to brain causing various central nervous system complications like stroke and brain abscess, hemoptysis and rupture. The age at the presentation can range from 1st to 7th decade but the majority of patients present before the age of 30 years. PAVM is strongly associated with hereditary haemorrhagic telangiectasis which presents with epistaxis, mucocutaneous telangiectasias and AV malformations of various organs. In our case series, we have patients ranging from 3 yrs to 75 years with presentation ranging from asymptomatic to exertional dyspnea, hemoptysis and neurological complications.

scholarly journals Neurologic Manifestation as Initial Presentation in a Case of Hereditary Haemorrhagic Telangiectasia

2010 ◽  
Vol 3 ◽  
pp. CCRep.S4749
Author(s):  
Yeow Kwan Teo ◽  
Ai Ching Kor
Keyword(s):  
Arteriovenous Malformations ◽  
Autosomal Dominant ◽  
Cerebral Abscess ◽  
Initial Presentation ◽  
Hereditary Haemorrhagic Telangiectasia ◽  
Pulmonary Arteriovenous Malformations ◽  
Gastrointestinal Involvement ◽  
Neurologic Manifestation ◽  
Life Threatening ◽  
Paradoxical Emboli

Hereditary Haemorrhagic Telangiectasia (HHT), or Osler-Weber-Rendu syndrome is an uncommon autosomal dominant multi-organ condition of vascular dysplasias. We describe a 19 year old Indian female who presented with cerebral abscess secondary to paradoxical emboli from pulmonary arteriovenous malformations (PAVMs) associated with HHT. Cerebral, pulmonary, hepatic and gastrointestinal involvement can be life-threatening and it is important to have lifelong follow-ups on these patients.

scholarly journals Pulmonary Arteriovenous Malformations: Current Technique of Transcatheter Embolization and Subsequent Management

2017 ◽  
Vol 2 (3) ◽  
pp. 116-121 ◽  
Author(s):  
Masashi Shimohira ◽  
Tatsuya Kawai ◽  
Takuya Hashizume ◽  
Kengo Ohta ◽  
Kazushi Suzuki ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Transcatheter Embolization ◽  
Pulmonary Arteriovenous Malformations ◽  
Current Technique

scholarly journals Pulmonary arteriovenous malformations: diagnostic and treatment characteristics

2019 ◽  
Vol 45 (4) ◽  
Author(s):  
William Salibe-Filho ◽  
Bruna Mamprim Piloto ◽  
Ellen Pierre de Oliveira ◽  
Marcela Araújo Castro ◽  
Breno Boueri Affonso ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Case Series ◽  
Transcatheter Embolization ◽  
Pulmonary Angiography ◽  
Clinical Findings ◽  
Pulmonary Arteriovenous Malformations ◽  
Vascular Abnormalities ◽  
Computed Tomographic ◽  
Clinical Complications ◽  
The Mean

ABSTRACT Objective: To present a case series of pulmonary arteriovenous malformations (PAVMs), describing the main clinical findings, the number/location of pulmonary vascular abnormalities, the clinical complications, and the treatment administered. Methods: This was a retrospective observational study evaluating patients with PAVM divided into two groups: hereditary hemorrhagic telangiectasia (HHT); and idiopathic PAVM (iPAVM). Results: A total of 41 patients were selected for inclusion, but only 33 had PAVMs. After clinical evaluation, 27 and 6 were diagnosed with HHT and iPAVM, respectively. In the HHT group, the mean age was 49.6 years and 88.9% were female. In that group, 4 patients had an SpO2 of < 90% and the most common clinical finding was epistaxis. In the iPAVM group, the mean age was 48.1 years and 83.3% were female. In that group, 3 patients had an SpO2 of < 90%. Computed tomographic pulmonary angiography showed that most of the PAVMs were in the lower lobes: 56.4% in the HHT group and 85.7% in the iPAVM group. Embolization was performed in 23 patients (in both groups). At this writing, 10 patients are scheduled to undergo the procedure. One of the patients who underwent embolization was subsequently referred for pulmonary resection. Conclusions: In both of the PAVM groups, there was a predominance of women and of fistulas located in the lower lobes. Few of the patients had respiratory symptoms, and most had an SpO2 > 90%. The treatment chosen for all patients was percutaneous transcatheter embolization.

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