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CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2017; 01(03): 156-160
DOI: 10.1055/s-0037-1604096
Original Article
Indian Society of Vascular and Interventional Radiology

Clinical Significance of Pulmonary Arteriovenous Malformation Reperfusion

Claire Kaufman
1   Department of Radiology, University of California San Diego School of Medicine, San Diego, California, United States
,
Katharine Henderson
2   Department Radiology and Biomedical Imaging and the Yale HHT Center, Yale University School of Medicine, New Haven, Connecticut, United States
,
Jeffrey Pollak
2   Department Radiology and Biomedical Imaging and the Yale HHT Center, Yale University School of Medicine, New Haven, Connecticut, United States
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Publikationsverlauf

20. März 2017

29. Mai 2017

Publikationsdatum:
01. September 2017 (online)

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Abstract

The purpose of this study was to assess the clinical significance of reperfused pulmonary arteriovenous malformations (rPAVM) after embolization. This study is a retrospective review of all patients from a single HHT center who underwent pulmonary arteriovenous malformation (PAVM) embolization between January 1, 2006 and December 30, 2007. Clinical history, imaging findings (including reperfusion), and symptoms seen in the setting of PAVMs were reviewed both at the time of embolization and during the subsequent follow-up through December 30, 2013. During the 2-year treatment period, 101 patients underwent PAVM embolization. During the initial embolization, 27 patients were found to have reperfusion of a previously embolized PAVM. During the follow-up period, none of these patients had recurrence of the rPAVM. Three patients who underwent an embolization procedure for the first time at the initial procedure were subsequently found to have rPAVM during the follow-up period. This resulted in a total of 30 patients with rPAVMs. Eighteen (60%) of the 30 patients were found to be symptomatic at the time of presentation with rPAVM. However, 14 had at least one other significant PAVM at the time of diagnosis of reperfusion. Only two symptomatic patients had only rPAVM, both with mild manifestations. Two patients were excluded from the study as their symptoms were attributed to other medical comorbidities. The majority of symptomatic patients with rPAVM had additional PAVMs that required embolization. Neither of the symptomatic patients with an isolated rPAVM had severe manifestations.

Keywords

pulmonary arteriovenous malformation - embolization - hereditary hemorrhagic telangiectasia
 

  • References

  • 1 Bosher Jr LH, Blake DA, Byrd BR. An analysis of the pathologic anatomy of pulmonary arteriovenous aneurysms with particular reference to the applicability of local excision. Surgery 1959; 45 (01) 91-104
    PubMedGoogle Scholar
  • 2 Cartin-Ceba R, Swanson KL, Krowka MJ. Pulmonary arteriovenous malformations. Chest 2013; 144 (03) 1033-1044
    CrossrefPubMedGoogle Scholar
  • 3 Trerotola SO, Pyeritz RE. PAVM embolization: an update. AJR Am J Roentgenol 2010; 195 (04) 837-845
    CrossrefPubMedGoogle Scholar
  • 4 Shovlin CL, Letarte M. Hereditary haemorrhagic telangiectasia and pulmonary arteriovenous malformations: issues in clinical management and review of pathogenic mechanisms. Thorax 1999; 54 (08) 714-729
    CrossrefPubMedGoogle Scholar
  • 5 White Jr RI, Pollak JS, Wirth JA. Pulmonary arteriovenous malformations: diagnosis and transcatheter embolotherapy. J Vasc Interv Radiol 1996; 7 (06) 787-804
    CrossrefPubMedGoogle Scholar
  • 6 Pollak JS, Saluja S, Thabet A, Henderson KJ, Denbow N, White Jr RI. Clinical and anatomic outcomes after embolotherapy of pulmonary arteriovenous malformations. J Vasc Interv Radiol 2006; 17 (01) 35-44 , quiz 45
    CrossrefPubMedGoogle Scholar
  • 7 Gossage JR, Kanj G. Pulmonary arteriovenous malformations. A state of the art review. Am J Respir Crit Care Med 1998; 158 (02) 643-661
    CrossrefPubMedGoogle Scholar
  • 8 Gupta P, Mordin C, Curtis J, Hughes JM, Shovlin CL, Jackson JE. Pulmonary arteriovenous malformations: effect of embolization on right-to-left shunt, hypoxemia, and exercise tolerance in 66 patients. AJR Am J Roentgenol 2002; 179 (02) 347-355
    CrossrefPubMedGoogle Scholar
  • 9 Haitjema TJ, Overtoom TT, Westermann CJ, Lammers JW. Embolisation of pulmonary arteriovenous malformations: results and follow up in 32 patients. Thorax 1995; 50 (07) 719-723
    CrossrefPubMedGoogle Scholar
  • 10 Mager JJ, Overtoom TT, Blauw H, Lammers JW, Westermann CJ. Embolotherapy of pulmonary arteriovenous malformations: long-term results in 112 patients. J Vasc Interv Radiol 2004; 15 (05) 451-456
    CrossrefPubMedGoogle Scholar
  • 11 Puskas JD, Allen MS, Moncure AC. , et al. Pulmonary arteriovenous malformations: therapeutic options. Ann Thorac Surg 1993; 56 (02) 253-257 , discussion 257–258
    CrossrefPubMedGoogle Scholar
  • 12 Swanson KL, Prakash UB, Stanson AW. Pulmonary arteriovenous fistulas: Mayo Clinic experience, 1982–1997. Mayo Clin Proc 1999; 74 (07) 671-680
    CrossrefPubMedGoogle Scholar
  • 13 White Jr RI, Lynch-Nyhan A, Terry P. , et al. Pulmonary arteriovenous malformations: techniques and long-term outcome of embolotherapy. Radiology 1988; 169 (03) 663-669
    CrossrefPubMedGoogle Scholar
  • 14 Vettukattil JJ. Pathogenesis of pulmonary arteriovenous malformations: role of hepatopulmonary interactions. Heart 2002; 88 (06) 561-563
    CrossrefPubMedGoogle Scholar
  • 15 Porstmann W. Therapeutic Embolization of Arteriovenous Pulmonary Fistula by Catheter Technique. Berlin, Germany: Springer; 1977
    Google Scholar
  • 16 White Jr RI. Pulmonary arteriovenous malformations: how do we diagnose them and why is it important to do so?. Radiology 1992; 182 (03) 633-635
    CrossrefPubMedGoogle Scholar
  • 17 Woodward CS, Pyeritz RE, Chittams JL, Trerotola SO. Treated pulmonary arteriovenous malformations: patterns of persistence and associated retreatment success. Radiology 2013; 269 (03) 919-926
    CrossrefPubMedGoogle Scholar
  • 18 Lee DW, White Jr RI, Egglin TK. , et al. Embolotherapy of large pulmonary arteriovenous malformations: long-term results. Ann Thorac Surg 1997; 64 (04) 930-939 , discussion 939–940
    CrossrefPubMedGoogle Scholar
  • 19 Milic A, Chan RP, Cohen JH, Faughnan ME. Reperfusion of pulmonary arteriovenous malformations after embolotherapy. J Vasc Interv Radiol 2005; 16 (12) 1675-1683
    CrossrefPubMedGoogle Scholar
  • 20 Sagara K, Miyazono N, Inoue H, Ueno K, Nishida H, Nakajo M. Recanalization after coil embolotherapy of pulmonary arteriovenous malformations: study of long-term outcome and mechanism for recanalization. AJR Am J Roentgenol 1998; 170 (03) 727-730
    CrossrefPubMedGoogle Scholar
  • 21 Trerotola SO, Pyeritz RE, Bernhardt BA. Outpatient single-session pulmonary arteriovenous malformation embolization. J Vasc Interv Radiol 2009; 20 (10) 1287-1291
    CrossrefPubMedGoogle Scholar
  • 22 Todo K, Moriwaki H, Higashi M, Kimura K, Naritomi H. A small pulmonary arteriovenous malformation as a cause of recurrent brain embolism. AJNR Am J Neuroradiol 2004; 25 (03) 428-430
    PubMedGoogle Scholar
  • 23 Shovlin CL, Jackson JE, Bamford KB. , et al. Primary determinants of ischaemic stroke/brain abscess risks are independent of severity of pulmonary arteriovenous malformations in hereditary haemorrhagic telangiectasia. Thorax 2008; 63 (03) 259-266
    CrossrefPubMedGoogle Scholar
  • 24 Andersen PE, Kjeldsen AD. Embolization of pulmonary AVMs of feeding arteries less than 3 mm: reports of two cases and an 8-year follow-up without embolization. Acta Radiol Short Rep 2012; 1 (02) arsr.2012.120001
    PubMedGoogle Scholar
  • 25 Saluja S, Sitko I, Lee DW, Pollak J, White Jr RI. Embolotherapy of pulmonary arteriovenous malformations with detachable balloons: long-term durability and efficacy. J Vasc Interv Radiol 1999; 10 (07) 883-889
    CrossrefPubMedGoogle Scholar