Management of a Patient with a Clot-filled Pulmonary Arteriovenous Malformation

Graves, Andrew D.; Gregorius, John C.; Smith, Douglas C.

doi:10.1016/j.jvir.2009.01.026

Cited by 5 publications

(5 citation statements)

References 9 publications

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“…Pulmonary arteriovenous fistula (PAVF) is a rare pulmonary vascular malformation that allows direct communication between the pulmonary artery and vein, bypassing the capillaries [ 1 ]. PAVF is mainly congenital but can be acquired in some cases, such as in patients with cirrhosis or those undergoing surgery for congenital heart disease.…”

Section: Introductionmentioning

confidence: 99%

Attention to pulmonary arteriovenous fistula in a case of transient hypoxemia and cerebral infarction during pregnancy: a case report and literature review

Shu,

Luo,

Zuo

2023

BMC Pregnancy Childbirth

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Background Pulmonary arteriovenous fistula is rare during pregnancy. Pulmonary arteriovenous fistula presents no pulmonary symptoms in most patients but can be exacerbated by pregnancy. If not diagnosed and treated promptly, pulmonary arteriovenous fistula can lead to respiratory failure, stroke, spontaneous hemothorax, or other fatal complications. Case presentation A 29-year-old healthy pregnant woman presented with a transient drop in blood oxygen level of unknown cause during a routine examination at 34 weeks of gestation and during a cesarean section at 38 weeks of pregnancy. The patient’s oxygen saturation quickly returned to normal and was not further investigated. On day 3 postpartum, the patient suddenly displayed slurred speech and right limb myasthenia. A head magnetic resonance imaging revealed cerebral infarction in the left basal ganglia. Subsequent computed tomography pulmonary arteriography revealed bilateral pulmonary arteriovenous fistula, which was likely the cause of cerebral infarction. The patient was transferred to the Department of Thoracic Surgery after one month of treatment and successfully underwent percutaneous embolization of pulmonary arteriovenous fistula. Conclusion Pulmonary arteriovenous fistula should not be neglected if a pregnant woman presents with transient hypoxemia and cerebral infarction. A transient decrease in pulse oxygen saturation that cannot be explained by common clinical causes can be an early warning sign of the disease. Early diagnosis and multidisciplinary management could improve the prognosis.

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Section: Introductionmentioning

confidence: 99%

Attention to pulmonary arteriovenous fistula in a case of transient hypoxemia and cerebral infarction during pregnancy: a case report and literature review

Shu,

Luo,

Zuo

2023

BMC Pregnancy Childbirth

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“…The acute PE in a patient with PAVM is a predisposing factor for life-threatening complications, such as stroke, and there have been few reports of cases in which they were found at the same time and how they were treated (Graves et al, 2009 ; Serra et al, 2015 ; Luis et al, 2021 ). Although HHT, a disease related to PAVM, has been reported to be associated with an increase in thrombotic risk due to iron deficiency (Shovlin et al, 2014 ), patients with both PAVM and PE are rare.…”

Section: Discussionmentioning

confidence: 99%

“…According to Graves et al (Graves et al, 2009 ), the acute on chronic PE in a patient with multiple-infarct dementia due to a large PAVM was successfully treated with concurrent anticoagulation and endovascular embolization. Considering the nature of PE, they judged that the risk of migration through minimal catheter manipulation was not high, and the benefit from blocking the shunt was greater.…”

Section: Discussionmentioning

confidence: 99%

Concurrent pulmonary arteriovenous malformation and pulmonary embolism causing stroke: a therapeutic dilemma

Guen

Hong

2022

CVIR Endovasc

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Background As pulmonary arteriovenous malformation (PAVM) include a right-to-left shunt, it can be accompanied by fatal complications such as stroke and brain abscess due to paradoxical embolism. A concurrent PAVM and pulmonary embolism (PE) is a rare condition. Therefore, the sequence of management has not been established. Case presentation A 62-year-old female patient was transferred to our hospital with a sporadic simple PAVM and concurrent bilateral PE. On chest computed tomography (CT), the acute PE was extended to the segmental pulmonary artery where the feeding artery of PAVM originated. Despite the anticoagulation, the patient complained of left sided weakness on the fifth day of admission, and magnetic resonance imaging revealed an acute infarction in the right lateral thalamus, which was thought to be caused by paradoxical embolism. This situation could lead to a dilemma between the risk of thrombus migration during PAVM embolization and another embolic event due to delayed shunt occlusion during anticoagulation. After a multidisciplinary discussion, a delayed endovascular embolization was performed for PAVM after confirming the complete resolution of PE with 4 months of anticoagulation. The cause of PE in this patient was eventually diagnosed as antiphospholipid syndrome. Conclusion The authors reported a rare case of concurrent PAVM and PE that led to an embolic stroke during hospitalization. This patient was managed with delayed endovascular embolization for PAVM after an anticoagulation for PE and stroke. It is thought to be valuable in deciding for a treatment plan for this rare condition.

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“…The acute PE in PAVM is a predisposing for life-threatening complications, such as stroke, and there have been few reports of cases in which they were found at the same time and how they were treated (Graves et al, 2009;Serra et al, 2015). Although hereditary hemorrhagic telangiectasia itself, a disease related to PAVM, promotes a hypercoagulable state (Shovlin et al, 2007), patients with both PAVM and PE are very rare.…”

Section: Discussionmentioning

confidence: 99%

“…According to Graves et al (Graves et al, 2009), the acute on chronic PE in a patient with multiple-infarct dementia due to a large PAVM was successfully treated with concurrent anticoagulation and endovascular embolization. Considering the nature of PE, they judged that the risk of migration through minimal catheter manipulation was not high, and the bene t from blocking the shunt was greater.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Arteriovenous Malformation in Combination With Stroke.

Guen

Hong

2021

Preprint

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BackgroundAs pulmonary arteriovenous malformation (PAVM) include a right-to-left shunt, it can be accompanied by fatal complications such as stroke and brain abscess due to paradoxical embolism. There are few PAVM patients accompanied by concurrent pulmonary embolism, so the treatment sequence has not been established. Case presentationA 62-year-old female patient was transferred to our hospital with a simple PAVM and concurrent bilateral pulmonary embolism (PE). The acute thromboembolus was extended to the proximal segmental artery where the feeding artery originated. Anticoagulation was started, but on the fifth day of admission, the patient complained of left side weakness and brain magnetic resonance imaging revealed an acute infarction in the right lateral thalamus. This situation could lead to a dilemma between the risk of thrombus migration during catheter manipulation in PAVM embolization and another embolic event due to the late occlusion of the shunt during anticoagulation. This complex situation was successfully managed with delayed endovascular embolization for PAVM after four months of anticoagulation. The cause of PE in this patient was eventually diagnosed as antiphospholipid syndrome (APS).ConclusionThe authors reported a rare case of APS-induced PE in the PAVM feeding artery course that led to stroke during hospitalization. We successfully treated this patient with delayed endovascular embolization for PAVM after anticoagulation for PE and stroke. It is thought to be valuable in deciding for a treatment plan for this rare condition.

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Management of a Patient with a Clot-filled Pulmonary Arteriovenous Malformation

Cited by 5 publications

References 9 publications

Attention to pulmonary arteriovenous fistula in a case of transient hypoxemia and cerebral infarction during pregnancy: a case report and literature review

Attention to pulmonary arteriovenous fistula in a case of transient hypoxemia and cerebral infarction during pregnancy: a case report and literature review

Concurrent pulmonary arteriovenous malformation and pulmonary embolism causing stroke: a therapeutic dilemma

Pulmonary Arteriovenous Malformation in Combination With Stroke.

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