Surgery versus percutaneous transcatheter embolization for pulmonary arteriovenous malformation: Analysis of a national inpatient database in Japan

Nagano, Masaaki; Ichinose, Junji; Sasabuchi, Yusuke; Nakajima, Jun; Yasunaga, Hideo

doi:10.1016/j.jtcvs.2017.04.069

Cited by 21 publications

(22 citation statements)

References 28 publications

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“…Although there is no high level of evidence for surgery in treatment of PAVM, retrospective case reports and case series have shown good results (8,(33)(34)(35)(36)(37).…”

Section: Resultsmentioning

confidence: 99%

Uniportal thoracoscopic surgery for pulmonary arteriovenous malformations—report of technique and case series

Flury¹,

Kocher²,

Lutz³

et al. 2020

Curr Chall Thorac Surg

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Background: Pulmonary arteriovenous malformations (PAVM) are abnormal direct connections between arteries and veins of the pulmonary circulatory system. In the majority of cases, they are of congenital origin and patients present with dyspnea, epistaxis or hemoptysis as the most common clinical symptoms.Before surgical treatment is considered, patients should be discussed interdisciplinary with angiologists and interventional radiologists regarding evaluation of embolotherapy. In case of unsuccessful embolotherapy, in case of complications (e.g., bleeding due to rupture of lesions), or in patients with contraindication for embolization such as untreatable contrast allergy, surgical resection of the pulmonary lesion is indicated. The former gold standard of open thoracotomy as treatment of PAVM has been mostly replaced by interventional embolization since the late 1980s. In recent years, less invasive approaches such as multi-or uniportal videoassisted thoracic surgeries (VATS) developed, have improved and have been shown to be safe and feasible treatment options, when surgery is necessary.Methods: Between October 2015 and August 2019 five patients suffering from PAVM or its complications underwent a uniportal lung-sparing VATS resection at our department. Four out of the five patients have been successfully treated with a sublobar resection (segmentectomy of one or two lung segments). In another patient, an extended vascular malformation between the superior phrenic artery and the inferior pulmonary vein was approached via wedge resection of the affected lung in a first step and embolization of the subphrenic part in a second step as decided in an interdisciplinary setting before treatment.Results: The median hospital stay was 4 days (range, 2-5 days) and, in all surgically treated patients, the postoperative course was uneventful. Only one of the five patients who suffered from hereditary hemorrhagic telangiectasia showed recurrence of the disease in the form of new vascular malformations in other lobes on CT scan 9 months after surgery, although so far asymptomatic. All other patients had an uneventful longtime course (median follow-up: 17 months; range, 5-52 months). Conclusions:The uniportal VATS technique is one of the least invasive approaches in thoracic surgery: It allows not only for lung-sparing anatomical lung resections in the form of segmentectomies, but is also associated with very low morbidity and complication rates. Therefore, uniportal VATS is an excellent therapeutic option in selected cases in which primary interventional measures fail or complications of PAVM occur.

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“…Although there is no high level of evidence for surgery in treatment of PAVM, retrospective case reports and case series have shown good results (8,(33)(34)(35)(36)(37).…”

Section: Resultsmentioning

confidence: 99%

Uniportal thoracoscopic surgery for pulmonary arteriovenous malformations—report of technique and case series

Flury¹,

Kocher²,

Lutz³

et al. 2020

Curr Chall Thorac Surg

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“…Treatment options of PAVMs include surgical resection, endovascular embolisation, and conservative medical treatment [ 24 , 26 , 40 ]. Patients with active massive haemorrhage have a high mortality rate during surgical resection because of haemorrhagic anemia, acute respiratory failure, hemodynamic instability.…”

Section: Discussionmentioning

confidence: 99%

“…Endovascular management of PAVMs has been the first-line treatment in lieu of surgery over the last few decades [ 6 , 24 , 25 ]. Treatment of ruptured PAVMs has only been described in isolated case reports [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

Massive haemorrhagic complications of ruptured pulmonary arteriovenous malformations: outcomes from a 12 years’ retrospective study

Jie

et al. 2021

BMC Pulm Med

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Background The life-threatening haemorrhagic complications of pulmonary arteriovenous malformations (PAVMs) are extremely rare, and only described in isolated cases. This study was designed to comprehensively investigate management of ruptured PAVMs. Methods We retrospectively assessed clinical and imaging data of ruptured PAVMs to summarize incidence, clinical characteristics, and outcomes following embolisation between January 2008 and January 2021. Results Eighteen of 406 (4.4%) patients with PAVMs developed haemorrhagic complications. Twelve of 18 patients were clinically diagnosed with hereditary haemorrhagic telangiectasia (HHT). Haemorrhagic complications occurred with no clear trigger in all cases. Eight of 18 patients (44.4%) were initially misdiagnosed or had undergone early ineffective treatment. 28 lesions were detected, with 89.3% of them located in peripheral lung. Computed tomography angiography (CTA) showed indirect signs to indicate ruptured PAVMs in all cases. Lower haemoglobin concentrations were associated with the diameter of afferent arteries in the ruptured lesions. Successful embolotherapy was achieved in all cases. After embolotherapy, arterial oxygen saturation improved and bleeding was controlled (P < 0.05). The mean follow-up time was 3.2 ± 2.5 years (range, 7 months to 10 years). Conclusions Life threatening haemorrhagic complications of PAVMs are rare, they usually occur without a trigger and can be easily misdiagnosed. HHT and larger size of afferent arteries are major risk factors of these complications. CTA is a useful tool for diagnosis and therapeutic guidance for ruptured PAVMs. Embolotherapy is an effective therapy for this life-threatening complication.

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“…By considering the patient factors such as the feeding artery diameter, PAVM-related symptoms, and the patient's ability to tolerate the procedure, timing and methods of intervention should be determined [ 2 ]. Embolotherapy demonstrated better outcomes rather than surgery in terms of success rate and complications [ 3 ]. Among other materials, coils have been used for embolization to PAVMs although long-term complications related to coil embolization have been reported such as endobronchial coil migration [ 4 , 5 ], hemoptysis [ 6 ], or worsening of pulmonary hypertension [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Migrated coil expectorated 12 years after embolization of pulmonary arteriovenous malformation, due probably to abscess formation around the coil

Konno-Yamamoto

Yamamoto

Suzuki

et al. 2020

Respiratory Medicine Case Reports

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Pulmonary arteriovenous malformations (PAVMs) are rare vascular structures providing direct capillary-free communications between pulmonary arteries and veins. Embolotherapy is indicated as a front-line therapy. We report an unusual long-term complication of coil embolization for a 44-year-old woman with hereditary hemorrhagic telangiectasia (HHT) who had repeatedly undergone the procedures for her PAVMs. She expectorated the coil which had been placed 12 years earlier and migrated to the bronchus according to the chest radiogram and bronchoscopy. Histology of the resected lung segment suggested the cavity communicating with the bronchus was the consequence of abscess formation around the coils. Even after technically successful embolization to PAVMs, long term follow-up should be necessary paying attention to the symptoms and imaging to avoid massive hemoptysis and subsequent emergency surgery.

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Surgery versus percutaneous transcatheter embolization for pulmonary arteriovenous malformation: Analysis of a national inpatient database in Japan

Cited by 21 publications

References 28 publications

Uniportal thoracoscopic surgery for pulmonary arteriovenous malformations—report of technique and case series

Uniportal thoracoscopic surgery for pulmonary arteriovenous malformations—report of technique and case series

Massive haemorrhagic complications of ruptured pulmonary arteriovenous malformations: outcomes from a 12 years’ retrospective study

Migrated coil expectorated 12 years after embolization of pulmonary arteriovenous malformation, due probably to abscess formation around the coil

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