Treatment of Recurrent Pulmonary Arteriovenous Malformations: Comparison of Proximal Versus Distal Embolization Technique

Cusumano, Lucas R.; Duckwiler, Gary; Roberts, Dustin G.; McWilliams, J.

doi:10.1007/s00270-019-02328-0

Cited by 21 publications

(16 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Most complex PAVMs persist in a reperfusion rather than recanalization pattern, suggesting that at the time of initial embolization, thorough investigation of collateral branches and accessory feeder vessels to complex PAVMs should be performed, to reduce the risk of later reperfusion [65]. The most recent data reaffirms that persistent PAVMs are difficult to treat, but indicates that distal embolization beyond the existing embolic results in more durable occlusion [65]. This is consistent with similar findings from previous reports [57,63].…”

Section: Persistent Pavmssupporting

confidence: 87%

“…The characteristics and treatment outcomes of persistent PAVMs described in the literature reveal several patterns which can be used to guide interventional management. Most complex PAVMs persist in a reperfusion rather than recanalization pattern, suggesting that at the time of initial embolization, thorough investigation of collateral branches and accessory feeder vessels to complex PAVMs should be performed, to reduce the risk of later reperfusion [65]. The most recent data reaffirms that persistent PAVMs are difficult to treat, but indicates that distal embolization beyond the existing embolic results in more durable occlusion [65].…”

Section: Persistent Pavmsmentioning

confidence: 99%

“…It is hypothesized that distal embolization may be more successful by allowing placement of embolic material directly into the PAVM sac or nidus, resulting in more durable occlusion regardless of angioarchitecture [65][66][67][68]. However, it should be noted that the distal embolization technique is not always technically feasible, since the previously deposited embolic material may prevent distal access [57,63,65]. One study reports a high success rate treating recanalized PAVMs using coils in conjunction with Amplatzer vascular plugs [61].…”

Section: Persistent Pavmsmentioning

confidence: 99%

See 2 more Smart Citations

Approach to Pulmonary Arteriovenous Malformations: A Comprehensive Update

Majumdar

McWilliams

2020

JCM

Self Cite

View full text Add to dashboard Cite

Pulmonary arteriovenous malformations (PAVMs) are abnormal direct vascular communications between pulmonary arteries and veins which create high-flow right-to-left shunts. They are most frequently congenital, usually in the setting of hereditary hemorrhagic telangiectasia (HHT). PAVMs may be asymptomatic or present with a wide variety of clinical manifestations such as dyspnea, hypoxemia, or chest pain. Even when asymptomatic, presence of PAVMs increases patients’ risk of serious, potentially preventable complications including stroke or brain abscess. Transcatheter embolotherapy is considered the gold standard for treatment of PAVMs. Though previous guidelines have been published regarding the management of PAVMs, several aspects of PAVM screening and management remain debated among the experts, suggesting the need for thorough reexamination of the current literature. The authors of this review present an updated approach to the diagnostic workup and management of PAVMs, with an emphasis on areas of controversy, based on the latest literature and our institutional experience.

show abstract

Section: Persistent Pavmssupporting

confidence: 87%

Section: Persistent Pavmsmentioning

confidence: 99%

Section: Persistent Pavmsmentioning

confidence: 99%

See 1 more Smart Citation

Approach to Pulmonary Arteriovenous Malformations: A Comprehensive Update

Majumdar

McWilliams

2020

JCM

Self Cite

View full text Add to dashboard Cite

show abstract

“…Patients who exhibited exercise induced fatigue and dyspnea were considered "symptomatic," and were classi ed using the New York Heart Association (NYHA) functional classi cation (13). We excluded patients with other conditions which may produce symptoms that overlap with heart failure, such as untreated pulmonary arteriovenous malformations (PAVMs), symptomatic anemia or asthma (14)(15)(16)(17)(18)(19). Patients were deemed to have symptomatic anemia and excluded from the study if the heart failure symptoms correlated with hemoglobin levels or clinically signi cant bleeding events.…”

Section: Clinical Characteristicsmentioning

confidence: 99%

Predictors of Heart Failure Symptoms in Hereditary Hemorrhagic Telangiectasia Patients With Hepatic Arteriovenous Malformations

Cusumano

Tesoriero

Wilsen

et al. 2021

Preprint

View full text Add to dashboard Cite

BackgroundHepatic arteriovenous malformations (AVMs) in hereditary hemorrhagic telangiectasia (HHT) patients are most commonly hepatic artery to hepatic venous shunts which can result in high-output heart failure. This condition can be debilitating and is a leading cause of liver transplantation in HHT patients. However, it is not known what characteristics can discriminate between asymptomatic patients and those who will develop heart failure symptoms.Results176 patients with HHT were evaluated with computed tomography angiography (CTA) between April 2004 and February 2019 at our HHT Center of Excellence. 63/176 (35.8%) patients were found to have hepatic AVMs on CTA. 18 of these patients were excluded because of the presence of another condition which could confound evaluation of heart failure symptoms. In the remaining 45 patients included in our cohort, 25/45 (55.6%) patients were classified as asymptomatic and 20/45 (44.4%) were classified as symptomatic, and these groups were compared. In symptomatic patients, mean common hepatic artery (CHA) diameter was significantly higher (11.1 versus 8.4 mm) and mean hemoglobin levels were significantly lower (10.7 vs 12.6 g/dL). A stepwise multiple logistic regression analysis demonstrated that both CHA diameter and hemoglobin level were independent predictors of heart failure symptoms with ORs of 2.554 (95% CI 1.372-4.754) and 0.489 (95% CI 0.299-0.799), respectively. The receiver operator characteristic (ROC) curve of our analysis demonstrated an AUC of 0.906 (95% CI 0.816–0.996), sensitivity 80.0% (95% CI 55.7-93.4%), and specificity 75.0% (95% CI 52.9-89.4%).ConclusionsCTA is an effective and easily reproducible method to evaluate hepatic involvement of HHT. Utilizing CTA, clinical, and laboratory data we determined CHA diameter and hemoglobin level were independent predictors of heart failure symptoms.

show abstract

“…A pre-procedural plan involving emergency CTA was available for all patients, and the diameter of the afferent arteries was measured for all PAVMs, especially those suspected to have ruptured. Embolotherapy was performed from a transfemoral vein approach with placement of embolization coils (Cook Medical, Bloomington, IN, USA) or plugs (AGA Medical, Plymouth, MN, USA) in the distal aspect of all PAVMs according to the standard technique previously described [25][26][27].…”

Section: Treatment Processmentioning

confidence: 99%

Diagnosis and Transvascular Embolization for Ruptured Pulmonary Arteriovenous Malformations: Outcomes from a 12 Years’ Retrospective Study

Jie

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Pulmonary arteriovenous malformations (PAVMs) are rare, and the life-threatening hemorrhagic complications, including hemoptysis and hemothorax, are extremely uncommon. However, the management of large series of ruptured PAVMs has not been described in recent years. Methods We retrospectively reviewed patients who developed ruptured PAVMs between January 2008 and December 2019. We assessed the clinical and imaging data to summarize the incidence and characteristics of ruptured PAVMs, and outcomes following embolization with coils or plugs. A paired-sample t-test analysis, Kaplan–Meier method and the simple linear regression were accessed, as appropriate.Results Eighteen (5.49%) of 328 patients diagnosed with PAVMs developed hemorrhagic complications. Twelve of these 18 patients were clinically diagnosed with hereditary hemorrhagic telangiectasia (HHT) (incidence, 66.67%). Eleven of 18 patients were female. Eight of the 11 females were diagnosed with HHT. Twenty-eight lesions were detected, and the simple type was more common (82.14%) than the complex type. 89.29% of lesions were located in the peripheral lung. Computed tomography angiography (CTA) showed indirect signs to predict the ruptured PAVMs in cases of hemothorax. Technical success of embolotherapy was achieved in all cases. Two days after treatment, pulmonary function was significantly improved and bleeding was controlled (P<0.05), and no patients showed recanalization of PAVMs. Two patients in the hemoptysis group died of other reasons during follow-up and the mean follow-up time was 3.22±2.52 years (range, 7 months to 10 years). The hemorrhage volume was linearly associated with the diameter of the afferent arteries in the ruptured lesions.Conclusions CTA was able to diagnose ruptured PAVMs, and embolotherapy led to successful resolution of symptoms in all 18 patients who had ruptured PAVMs. Ruptured PAVMs must be considered when managing patients with hemothorax or hemoptysis, especially female patients with HHT.

show abstract

Treatment of Recurrent Pulmonary Arteriovenous Malformations: Comparison of Proximal Versus Distal Embolization Technique

Cited by 21 publications

References 30 publications

Approach to Pulmonary Arteriovenous Malformations: A Comprehensive Update

Approach to Pulmonary Arteriovenous Malformations: A Comprehensive Update

Predictors of Heart Failure Symptoms in Hereditary Hemorrhagic Telangiectasia Patients With Hepatic Arteriovenous Malformations

Diagnosis and Transvascular Embolization for Ruptured Pulmonary Arteriovenous Malformations: Outcomes from a 12 Years’ Retrospective Study

Contact Info

Product

Resources

About