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Thoracoscopic surgery for pulmonary arteriovenous malformation
Jun Nakajima1, Shinichi Takamoto, Eriho Takeuchi
1Department of Cardiothoracic Surgery, Faculty of Medicine, The University of Tokyo 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. nakajima-tho@h.u-tokyo.ac.jp
Abstract:
We report 6 consecutive cases of pulmonary arteriovenous malformation in the periphery of the lung, which were treated successfully by thoracoscopy. Pulmonary wedge resection was performed with a linear cutting stapler to divide the feeding artery, drainage vein, and aneurysmal lesion of the arteriovenous malformation. Operative time ranged from 30 to 95 min (mean, 50 min). Bleeding was minimal in all cases. No major surgery-related complications were observed. Postoperative hospital stay was limited to one week except for one patient who had experienced a brain infarction preoperatively, caused by migration of an embolization coil. Histological examination confirmed that the arteriovenous malformation foci were completely removed. Pulmonary wedge resection through thoracoscopy is feasible as an alternative treatment for arteriovenous malformation located in the periphery of the lung parenchyma when pulmonary embolization therapy is difficult or unsuccessful.
Insights
Thoracoscopic pulmonary wedge resection successfully treated peripheral pulmonary arteriovenous malformations in 6 patients. This minimally invasive approach offers a viable alternative when embolization is challenging or ineffective.
Area of Science:
- Cardiothoracic Surgery
- Pulmonary Medicine
- Vascular Surgery
Background:
- Pulmonary arteriovenous malformations (PAVMs) are abnormal connections between pulmonary arteries and veins.
- Peripheral PAVMs can be challenging to treat with conventional methods like embolization.
- Surgical intervention is sometimes necessary for complex or persistent PAVMs.
Purpose of the Study:
- To evaluate the efficacy and safety of thoracoscopic pulmonary wedge resection for peripheral PAVMs.
- To present surgical outcomes for a consecutive series of patients treated with this minimally invasive technique.
Main Methods:
- Six consecutive patients with peripheral PAVMs underwent thoracoscopic pulmonary wedge resection.
- A linear cutting stapler was used to resect the feeding artery, draining vein, and malformation.
- Operative details, complications, and postoperative outcomes were recorded.
Main Results:
- All 6 PAVMs were completely removed, confirmed by histology.
- Mean operative time was 50 minutes (range 30-95 minutes) with minimal bleeding.
- Postoperative hospital stay was one week, with no major surgery-related complications.
- One patient experienced a preoperative brain infarction due to embolization coil migration.
Conclusions:
- Thoracoscopic pulmonary wedge resection is a feasible and effective treatment for peripheral PAVMs.
- This minimally invasive technique provides a valuable alternative to embolization when it is difficult or unsuccessful.
- The procedure demonstrates good safety and efficacy for selected PAVM cases.
