Pulmonary arteriovenous malformations: endovascular therapy

Area of Science:

• Vascular Medicine
• Interventional Radiology
• Cardiopulmonary Medicine

Background:

• Pulmonary arteriovenous malformations (PAVMs) are direct abnormal connections between pulmonary arteries and veins.
• PAVMs are frequently associated with hereditary hemorrhagic telangiectasia (HHT).
• Untreated PAVMs can lead to hypoxemia, stroke, and intracranial abscess due to right-to-left shunting.

Purpose of the Study:

• To review the indications and contraindications for endovascular therapy in PAVMs.
• To detail the pre-procedural workup, procedural techniques, and variations.
• To discuss potential complications and outcomes associated with endovascular treatment of PAVMs.

Main Methods:

• Endovascular therapy involves occluding the feeding artery of the PAVM using coils, plugs, or a combination.
• This minimally invasive procedure is typically performed on an outpatient basis.
• The review synthesizes current literature on patient selection, procedural execution, and management of complications.

Main Results:

• Endovascular therapy is a safe and effective treatment for PAVMs.
• The procedure is associated with minimal morbidity and no mortality.
• Successful occlusion of feeding arteries leads to resolution of the right-to-left shunt and associated symptoms.

Conclusions:

• Endovascular therapy is the standard of care for symptomatic PAVMs, particularly in HHT patients.
• Careful patient selection and procedural technique are crucial for optimal outcomes.
• This approach effectively mitigates the risks of hypoxemia and paradoxical embolization.