Therapeutic Embolization of Arteriovenous Pulmonary Fistulas by Catheter Technique

Porstmann, W

doi:10.1007/978-1-4471-1288-4_3

Cited by 38 publications

(23 citation statements)

References 32 publications

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“…Out of .700 reported pulmonary AVM embolisations [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][34][35][36][37][38][39][40][41][42], data on Ppa measurements pre-and post-embolisation are scarce [9,11,17,32]. In three out of the four reported cases [9,17,32], each selected from larger series, Ppa increased postembolisation, while in the fourth it was unchanged [11].…”

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confidence: 99%

Embolisation of pulmonary arteriovenous malformations: no consistent effect on pulmonary artery pressure

Shovlin¹,

Tighe²,

Davies³

et al. 2008

Eur Respir J

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Increasing evidence supports the use of embolisation to treat pulmonary arteriovenous malformations (AVMs). Most pulmonary AVM patients have hereditary haemorrhagic telangiectasia (HHT), a condition that may be associated with pulmonary hypertension.The current authors tested whether pulmonary AVM embolisation increases pulmonary artery pressure (Ppa) in patients without baseline severe pulmonary hypertension. Ppa was measured at the time of pulmonary AVM embolisation in 143 individuals, 131 (92%) of whom had underlying HHT. Angiography/embolisation was not performed in four individuals with severe pulmonary hypertension, whose systemic arterial oxygen saturation exceeded levels usually associated with dyspnoea in pulmonary AVM patients.In 143 patients undergoing pulmonary AVM embolisation, Ppa was significantly correlated with age, with the most significant increase occurring in the upper quartile (aged .58 yrs). In 43 patients with repeated measurements, there was no significant increase in Ppa as a result of embolisation. In half, embolisation led to a fall in Ppa. The maximum rise in mean Ppa was 8 mmHg: balloon test occlusion was performed in one of these individuals, and did not predict the subsequent rise in Ppa following definitive embolisation of the pulmonary AVMs.In the present series of patients, which excluded those with severe pulmonary hypertension, pulmonary artery pressure was not increased significantly by pulmonary arteriovenous malformation embolisation.KEYWORDS: Brain abscess, hypoxaemia, nosebleeds, oxygen saturation, right-to-left shunt, stroke D oes embolisation of pulmonary arteriovenous malformations (AVMs) precipitate pulmonary hypertension (PH)? The reason this question is important is that for individuals with pulmonary AVMs, embolisation is an effective means of reducing lifetime risks of paradoxical embolic stroke and brain abscess [1,2], improving oxygenation [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] and treating pulmonary AVM-related haemoptysis [18,19]. Conversely, embolisation may be expected to elevate pulmonary artery pressure (Ppa), since pulmonary AVMs are abnormal dilated vessels between pulmonary arteries and veins that provide low resistance pathways for pulmonary blood flow [20].The question of whether pulmonary AVM embolisation increases Ppa is particularly pertinent, since most individuals with pulmonary AVMs have underlying hereditary haemorrhagic telangiectasia (HHT). Typically recognised by nosebleeds, mucocutaneous telangiectasia and visceral AVMs [21], HHT may be associated with PH [9,[22][23][24][25][26][27][28][29][30]. The secondary causes of PH in HHT are diverse, as they are in the normal population [31], but PH particularly occurs either as a true pulmonary arterial hypertension (PAH) phenotype [9,22,[28][29][30] or in the context of high output cardiac failure secondary to hepatic AVMs, when PH may be reversible after hepatic AVM treatment [32]. The frequencies of PAH and hepatic AVMs differ with HHT genotype: HHT is caused by mutatio...

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confidence: 99%

Embolisation of pulmonary arteriovenous malformations: no consistent effect on pulmonary artery pressure

Shovlin¹,

Tighe²,

Davies³

et al. 2008

Eur Respir J

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“…Miniaturization of catheters and re®nement in embolic agents de®nitely established bronchial artery embolization as an accepted technique. Similar vascular occlusion techniques were applied in pulmonary arteries, ®rst for treatment of haemoptysis, then as a means of occlusion of pulmonary arteriovenous ®stula, with coils or detachable balloons [10,11].…”

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Imaging guided thoracic interventions

Ghaye¹,

Dondelinger²

2001

Eur Respir J

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Interventional Radiology is a technique based medical specialty, using all available imaging modalities (¯uoroscopy, ultrasound, computed tomography, magnetic resonance, angiography) for guidance of interventional techniques for diagnostic or therapeutic purposes.Actual, percutaneous transthoracic needle biopsy includes core needle biopsy besides ®ne needle aspiration. Any pleural, pulmonary or mediastinal¯uid or gas collection is amenable to percutaneous pulmonary catheter drainage.Treatment of haemoptysis of the bronchial artery or pulmonary artery origin, transcatheter embolization of pulmonary arteriovenous malformations and pseudoaneurysms, angioplasty and stenting of the superior vena caval system and percutaneous foreign body retrieval are well established routine procedures, precluding unnecessary surgery. These techniques are safe and effective in experienced hands.Computed tomography is helpful in pre-and postoperative imaging of patients being considered for endobronchial stenting. Many procedures can be performed on an outpatient basis, thus increasing the cost-effectiveness of radiologically guided interventions in the thorax.

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“…Surgical resection was the only treatment available for PAVM until Porstmann fi rst reported TAE for PAVM in 1977. 1 Recent advances in interventional radiology have been so marked that radiologic procedures have been gradually supplanting traditional surgical procedures such as lobectomy of the lung through thoracotomy because of the lower morbidity and mortality rate and the preservation of a functioning lung. TAE has, however, the potential demerit of the persistence of a fi stula, which is mainly caused by insuffi cient embolization, recanalization, or growth of accessory vessels.…”

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confidence: 99%

Video-assisted thoracoscopic surgery for pulmonary arteriovenous malformations: report of five cases

Ishikawa

Yamanaka

Nishii

et al. 2008

Gen Thorac Cardiovasc Surg

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We experienced five cases of pulmonary arteriovenous malformations (PAVMs) that were successfully treated by video-assisted thoracoscopic surgery. Four malformations were treated by local wedge resection and one was treated by segmentectomy. Criteria for patient selection for surgery were peripheral and solitary lesions, with feeding arteries larger than 3 mm. Postoperative hospital stays were 1-7 days (median, 2 days). All patients showed unchanged or increased values of PaO(2) in arterial blood after operation. No major postoperative complication occurred in any patient, but a persistent air leak for 5 days occurred in the one patient who was treated by segmentectomy. No growth of accessory vessels or untreated malformations were seen in any patient throughout the follow-up period of 14-54 months. Thoracoscopic surgical resection for well-selected patients provides a high certainty of eliminating fistulae and was associated with lower morbidity, lower mortality, and shorter hospital stays.

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Therapeutic Embolization of Arteriovenous Pulmonary Fistulas by Catheter Technique

Cited by 38 publications

References 32 publications

Embolisation of pulmonary arteriovenous malformations: no consistent effect on pulmonary artery pressure

Embolisation of pulmonary arteriovenous malformations: no consistent effect on pulmonary artery pressure

Imaging guided thoracic interventions

Video-assisted thoracoscopic surgery for pulmonary arteriovenous malformations: report of five cases

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