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The Annals of Thoracic Surgery, Vol 56, 253-257, Copyright © 1993 by The Society of Thoracic Surgeons
JD Puskas, MS Allen, AC Moncure, JC Wain Jr, AD Hilgenberg, C Wright, HC Grillo and DJ Mathisen
We have treated 21 patients (13 female, 8 male) with pulmonary
arteriovenous malformations (PAVMs). Mean age at diagnosis was 37.5 years
(range, 15 to 72 years). Presenting symptoms included dyspnea on exertion
(67%), hereditary hemorrhagic telangiectasia (57%), and major neurologic
events (33%). In our early experience, 8 patients had no specific
treatment; their case histories illustrate the major neurologic
complications of untreated PAVMs. Nine patients (8 primarily, 1 after
recurrence) underwent conservative surgical excision; 4 had lobectomy, and
5 had segmentectomy or subsegmental excision. One patient underwent staged
bilateral thoracotomies for multiple bilateral lesions. The arterial oxygen
tension was found to increase after excision of large or solitary PAVMs.
All surgically treated patients were relieved of dyspnea, and none had
postoperative recurrence of PAVMs or neurologic complications related to
PAVMs. Five patients underwent balloon occlusion of PAVMs. Two patients
chose to have solitary PAVMs occluded rather than undergo thoracotomy. One
underwent surgical excision 5 years later, and the other required repeat
balloon embolization 4 years later when recanalization of the PAVMs was
documented. Three patients with numerous PAVMs received palliation with
multiple balloon embolizations. The high incidence of associated major
neurologic complications mandates aggressive treatment of PAVMs whenever
feasible. Conservative surgical resection remains the treatment of choice.
Balloon embolization offers an alternative therapy for patients who are
poor surgical risks or those whose lesions are too numerous to resect.
ARTICLES
Pulmonary arteriovenous malformations: therapeutic options
General Thoracic Surgical Unit, Massachusetts General Hospital, Harvard Medical School, Boston 02114.
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