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Pulmonary arteriovenous malformations in children: outcomes of transcatheter embolotherapy
Marie E Faughnan1, Ashraf Thabet, Meir Mei-Zahav
1Department of Medicine, Division of Respiratory Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. faughnanm@smh.toronto.on.ca
Insights
Transcatheter embolotherapy (TCE) effectively treats pulmonary arteriovenous malformations (PAVMs) in children, improving oxygenation and preventing further complications. This safe procedure shows complication rates similar to those in adults.
Area of Science:
- Pediatric Cardiology
- Interventional Radiology
- Vascular Malformations
Background:
- Pulmonary arteriovenous malformations (PAVMs) can lead to severe complications in children, including cyanosis and neurological events.
- Hereditary hemorrhagic telangiectasia is a common underlying condition associated with PAVMs.
Purpose of the Study:
- To evaluate the outcomes and safety of transcatheter embolotherapy (TCE) for treating PAVMs in pediatric patients.
- To assess the efficacy of TCE in improving clinical symptoms and preventing complications.
Main Methods:
- A retrospective chart and imaging review was conducted for all pediatric patients (age ≤18 years) treated for PAVMs with TCE.
- Data from three hereditary hemorrhagic telangiectasia centers were analyzed, including patient demographics, PAVM characteristics, treatment details, and follow-up outcomes.
Main Results:
- Forty-two children with PAVMs were treated with TCE. Pre-treatment symptoms included cyanosis (60%) and neurological complications (19%).
- Following TCE, significant improvement in oxygenation was observed in patients with focal PAVMs, with no new complications.
- TCE demonstrated a low rate of complications (e.g., chest pain, deployment issues), comparable to adult treatment rates, with no long-term adverse effects.
Conclusions:
- Transcatheter embolotherapy is a safe and effective treatment for pediatric pulmonary arteriovenous malformations.
- TCE significantly improves outcomes in children with PAVMs, offering a comparable safety profile to adult interventions.
Objective:
To describe outcomes of transcatheter embolotherapy (TCE) in children with pulmonary arteriovenous malformations (PAVMs).
Study Design:
Chart and imaging review of all children (age
Results:
All 42 treated patients were included, with a mean age of 12 years (range, 4 to 18). Cyanosis was present in 25 of 42 patients (60%). Hemoptysis had occurred in 3 of 42 patients (7%) and neurologic complications (stroke, cerebral abscess) occurred in 8 patients (19%) before assessment. PAVMs were focal in 30 of 42 (71%) and diffuse in 12 of 42 (29%) patients. TCE was performed for 172 PAVMs and 35 diffuse regions (regional TCE). Follow-up was obtained in 38 of 42 (90%) patients (mean, 7 years). After TCE in patients with focal PAVMs, oxygenation improved significantly, with no further complications from the PAVMs. Reperfusion was noted in 23 of 153 (15%) PAVMs. Eighteen of 23 (78 %) of these were retreated, with documented aneurysmal involution in 10 of 13 (77%) patients. TCE complications included pleuritic chest pain (24% of sessions) and deployment complications (device paradoxical embolization or device misplacement) (3% of sessions, 1% of PAVMs), with no long-term complications.
Conclusions:
PAVMs cause life-threatening complications in children; treatment with TCE is safe, with complication rates comparable to adult rates.
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