Pulmonary arteriovenous malformations: what the interventional radiologist needs to know

Area of Science:

• Radiology
• Vascular Medicine
• Interventional Cardiology

Background:

• Pulmonary arteriovenous malformations (PAVMs) are uncommon direct connections between pulmonary arteries and veins.
• Often congenital and linked to hereditary hemorrhagic telangiectasia, acquired PAVMs also occur.
• Timely diagnosis is crucial to prevent severe outcomes like stroke, embolization, hemoptysis, and hemothorax.

Purpose of the Study:

• To review the essential clinical and radiological features of PAVMs for accurate diagnosis.
• To provide an overview of current endovascular treatment strategies and embolization materials.
• To highlight the radiologist's critical role in PAVM diagnosis and management.

Main Methods:

• Review of clinical presentations and radiological findings of PAVMs.
• Discussion of imaging modalities including Chest X-ray, CT, and MRI for PAVM identification.
• Analysis of PAVM classification based on angioarchitecture (simple vs. complex).

Main Results:

• Imaging techniques are effective for PAVM diagnosis, classification, and treatment planning.
• Endovascular management is the preferred first-line treatment due to lower complication rates compared to surgery.
• Treatment selection and procedural success depend on pre-treatment imaging and appropriate embolic agents.

Conclusions:

• Radiologists are central to the diagnosis and management of PAVMs, employing various imaging modalities.
• Endovascular techniques offer a safe and effective alternative to surgery for PAVMs.
• Understanding PAVM angioarchitecture guides treatment decisions and optimizes outcomes.