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Pulmonary arteriovenous malformations. Case reports and literature review
P R Grahmann1, R Bonnet, L Swoboda
1Abteilung Lungenchirurgie/Chirurgische Universitätsklinik, Klinikum der Albert-Ludwigs-Universität Freiburg, Germany.
Abstract:
Pulmonary arteriovenous malformations (PAVM) represent an uncommon disease with only 500 reported cases. To emphasize the resectional surgical standard, 2 patients with PAVM and pulmonary right-to-left shunt are presented and the optional treatments discussed. One patient had suffered from a cerebrovascular accident. The other patient's diagnosis resulted from a coincidental finding in connection with an unrelated illness. Because of the risk of acutely developing complications, especially disabling or fatal cerebral ischemia, therapy is generally recommended even in asymptomatic patients. The 2 patients presented here were treated by resection. Surgical treatment with a very low risk and parenchyma-sparing technique remains the golden standard for large isolated malformations. In addition to the established and reliable operative therapy, since 1978 catheter embolization is becoming the method of choice with an increasing range of indications in those centers experienced with this technique.
Insights
Pulmonary arteriovenous malformations (PAVM) are rare. Surgical resection remains the standard treatment, even for asymptomatic patients, to prevent serious complications like stroke.
Area of Science:
- Vascular Surgery
- Interventional Radiology
Background:
- Pulmonary arteriovenous malformations (PAVM) are rare vascular anomalies.
- PAVMs can lead to significant complications, including pulmonary right-to-left shunting and potential cerebral ischemia.
Observation:
- Two patients with PAVM and pulmonary right-to-left shunt were treated surgically.
- One patient experienced a cerebrovascular accident prior to diagnosis; the other's PAVM was an incidental finding.
Findings:
- Surgical resection, particularly parenchyma-sparing techniques, is the gold standard for large, isolated PAVMs.
- Catheter embolization has emerged as an alternative treatment since 1978, with expanding indications.
Implications:
- Therapy for PAVM is recommended for all patients, even asymptomatic ones, due to the risk of severe complications.
- Surgical intervention offers a low-risk, parenchyma-sparing approach for complex PAVMs.