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Pulmonary arteriovenous malformations: therapeutic options
J D Puskas1, M S Allen, A C Moncure
1General Thoracic Surgical Unit, Massachusetts General Hospital, Harvard Medical School, Boston 02114.
The Annals of Thoracic Surgery
|August 1, 1993
Summary
Pulmonary arteriovenous malformations (PAVMs) require aggressive treatment due to severe neurologic risks. Conservative surgical resection is the preferred treatment, offering symptom relief and preventing complications.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Pulmonary Medicine
Background:
- Pulmonary arteriovenous malformations (PAVMs) are abnormal connections between pulmonary arteries and veins.
- PAVMs can lead to significant complications, including dyspnea, hereditary hemorrhagic telangiectasia, and major neurologic events.
Observation:
- This study reviewed 21 patients with PAVMs, analyzing treatment outcomes.
- Untreated PAVMs were associated with major neurologic complications.
- Surgical excision of PAVMs improved arterial oxygen tension and relieved dyspnea.
Findings:
- Conservative surgical resection (lobectomy, segmentectomy) was effective in all nine treated patients, with no recurrence or postoperative neurologic complications.
- Balloon occlusion was used in five patients, with mixed results including recanalization and need for repeat procedures.
- Surgical resection is the treatment of choice for PAVMs, while balloon embolization serves as an alternative for high-risk or complex cases.
Implications:
- Aggressive treatment of PAVMs is crucial to prevent severe neurologic complications.
- Conservative surgical resection is the most effective treatment for PAVMs.
- Balloon embolization provides a viable alternative for select patients unsuitable for surgery.