Pulmonary Arteriovenous Malformation Treated with Embolotherapy: Systemic Collateral Supply at Multidetector CT Angiography after 2–20-year Follow-up

Brillet, Pierre-Yves; Dumont, Philippe; Bouaziz, N; Duhamel, Alain; Laurent, François; Rémy, Jacques; Rémy‐Jardin, Martine

doi:10.1148/radiol.2421041571

Cited by 62 publications

(39 citation statements)

References 24 publications

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“…Unlike previously reported ASANL cases, we detected a newly developed hypertrophied bronchial artery soon after the ASA-embolization. Similar phenomena have been reported in the literature on embolization of pulmonary arteriovenous malformations (PAVMs) (8,9). In our case, the hypertrophied bronchial artery was possibly a preexisting lesion exaggerated by relative ischemia, or a new lesion caused by procedure-related local ischemia.…”

Section: Jksronlineorgsupporting

confidence: 89%

Transarterial Embolization Treatment for Aberrant Systemic Arterial Supply to the Normal Lung: A Case Report and Literature Review

Kim

Park

2017

J Korean Soc Radiol

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Section: Jksronlineorgsupporting

confidence: 89%

Transarterial Embolization Treatment for Aberrant Systemic Arterial Supply to the Normal Lung: A Case Report and Literature Review

Kim

Park

2017

J Korean Soc Radiol

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“…These are rare, reflecting the low pressures of the pulmonary circulation, but they are more common (1) in pregnancy (see below) [56,57] , (2) if PAVMs acquire a systemic arterial feeder after PAVM embolization [58] , or (3) in the setting of PH [31,59,60] . Emergency PAVM treatment by embolization or surgery is effective.…”

Section: Respiratory Manifestationsmentioning

confidence: 99%

The Lung in Hereditary Hemorrhagic Telangiectasia

2017

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Hereditary hemorrhagic telangiectasia (HHT) is a dominantly inherited genetic vascular disorder with an estimated prevalence of 1 in 6,000, characterized by recurrent epistaxis, cutaneous telangiectasia, and arteriovenous malformations (AVMs) that affect many organs including the lungs, gastrointestinal tract, liver, and brain. Its diagnosis is based on the Curaçao criteria, and is considered definite if at least 3 of the 4 following criteria are fulfilled: (1) spontaneous and recurrent epistaxis, (2) telangiectasia, (3) a family history, and (4) pulmonary, liver, cerebral, spinal, or gastrointestinal AVMs. The focus of this review is on delineating how HHT affects the lung.

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“…Clinical and imaging features of lung infarction are more frequent in patients with systemic collateral supply of PAVM as detected at multidetector CT angiography [124]. Major complications of the procedure (especially symptomatic lung infarction and systemic migration of the device through the PAVM) are rarely encountered and are prevented by careful positioning and adapting the size of the steel coils to the PAVM vessels [60, 63, 64].…”

Section: Treatment Of Pavmsmentioning

confidence: 99%

Pulmonary Vascular Manifestations of Hereditary Hemorrhagic Telangiectasia (Rendu-Osler Disease)

et al. 2007

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Hereditary hemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber disease is a genetic disorder with autosomal dominance and variable penetrance, characterized by epistaxis, telangiectasia and visceral manifestations of the disease. The estimated minimal prevalence is 1/10,000 inhabitants. The diagnosis is established on clinical criteria, and may be further confirmed by the identification of causative mutations in either the ENG or the ACVRL1 gene coding for endoglin and ALK1, respectively. Pulmonary vascular manifestations of HHT include pulmonary arteriovenous malforma- tions (PAVMs; especially in patients with ENG mutations) and less frequently pulmonary hypertension (especially in patients with ACVRL1 mutations). In 15–33% of patients with HHT, PAVMs consist of abnormal communications between pulmonary arteries and pulmonary veins, causing right-to-left shunting, and thus, frequently hypoxemia and dyspnea on exertion, although PAVMs may remain asymptomatic and frequently undiagnosed unless complications occur. PAVMs result in severe and frequent complications often at a young age, which may reveal the diagnosis, e.g. transient ischemic attack and cerebral stroke (10–19% of patients), systemic severe infections and abscesses (including cerebral abscess in 5–19% of patients), and rarely massive hemoptysis or hemothorax. Infections in HHT are related to the right-to-left shunting that bypasses the pulmonary capillaries and facilitates the passage of septic or aseptic emboli into the systemic and especially cerebral circulation, and potentially to minor defects in innate immunity. Treatment of PAVMs based on transcatheter coil vaso-occlusion of the feeding artery significantly decreases right-to-left shunting, hypoxemia and dyspnea on exertion, and reduces the risk of systemic complications. Long-term follow-up is warranted after transcatheter vaso-occlusion of PAVMs due to frequent recanalization of treated PAVMs and development or growth of untreated PAVMs. Patients with HHT should be informed of the risk of PAVM and potentially severe complications occurring in heretofore asymptomatic subjects. All adult patients with HHT should be proposed systematic screening for PAVM, by contrast echocardiography (preceded by anteroposterior chest radiograph) or computed tomography of the chest. Pulmonary hypertension is rare in HHT, and may be due either to systemic arteriovenous shunting in the liver increasing cardiac output or be clinically and histologically indistinguishable from idiopathic pulmonary arterial hypertension. Pulmonary hypertension is detected by systematic examination of right cardiac cavities and tricuspid regurgitation flow at echocardiography, and the diagnosis is established by right heart catheterization.

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Pulmonary Arteriovenous Malformation Treated with Embolotherapy: Systemic Collateral Supply at Multidetector CT Angiography after 2–20-year Follow-up

Abstract: Abnormally enlarged systemic arteries were present in 13 of 32 patients, in whom there was a significantly higher frequency of clinical and/or radiographic features suggestive of lung infarction after embolotherapy.

Cited by 62 publications

References 24 publications

Transarterial Embolization Treatment for Aberrant Systemic Arterial Supply to the Normal Lung: A Case Report and Literature Review

Transarterial Embolization Treatment for Aberrant Systemic Arterial Supply to the Normal Lung: A Case Report and Literature Review

The Lung in Hereditary Hemorrhagic Telangiectasia

Pulmonary Vascular Manifestations of Hereditary Hemorrhagic Telangiectasia (Rendu-Osler Disease)

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