Transpleural systemic artery-to-pulmonary artery communications in the absence of chronic inflammatory lung disease. A case series and review of the literature

Alsafi, Ali; Shovlin, CL; Jackson, James E.

doi:10.1016/j.crad.2021.03.016

Cited by 10 publications

(9 citation statements)

References 25 publications

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“…Traumatic origin is reported but notably, in our experience, these are almost always misdiagnosed systemic-topulmonary artery communications. 32 Most PAVMs are small with minimal effect on gas exchange. For larger PAVMs, even when significant hypoxemia and exuberant ventilation is present, dyspnea and exercise limitation is uncommon.…”

Section: Pavm Etiology and Complicationsmentioning

confidence: 99%

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Ischemic Stroke and Pulmonary Arteriovenous Malformations

et al. 2022

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The potential of covert pulmonary arteriovenous malformations (PAVMs) to cause early onset, preventable ischemic strokes is not well known to neurologists. This is evident by their lack of mention in serial American Heart Association/ American Stroke Association (AHA/ASA) Guidelines, and the single case-report biased literature of recent years. To inform, we performed PubMed and Cochrane database searches for major studies on ischemic stroke and PAVMs published from January 1, 1974 through April 3, 2021. This identified twenty-four major observational studies, three societal guidelines, one nationwide analysis, three systematic reviews, twenty-one other review/opinion articles, and eighteen recent (2017-2021) case-reports/series that were synthesized. Key points are that patients with PAVMs suffer ischemic stroke a decade earlier than routine stroke, losing nine extra healthy-life-years per patient in the recent US nationwide analysis (2005-2014). Large-scale thoracic CT screens of the general population in Japan estimate PAVM prevalence to be 38/100,000 (95% confidence interval 18-76), with ischemic stroke rates exceeding 10% across PAVM series dating back to the 1950s, with most PAVMs remaining undiagnosed until the time of clinical stroke. Notably, the rate of PAVM diagnoses doubled in US ischemic stroke hospitalizations between 2005-2014. The burden of silent cerebral infarction approximates to twice that of clinical stroke. Over 80% patients have underlying hereditary hemorrhagic telangiectasia (HHT). The predominant stroke mechanism is paradoxical embolization of platelet-rich emboli, with iron-deficiency emerging as a modifiable risk-factor. PAVM related ischemic strokes may be cortical or subcortical, but very rarely cause proximal large vessel occlusions. Single antiplatelet therapy maybe effective for secondary stroke prophylaxis, with dual antiplatelet or anticoagulation therapy requiring nuanced risk-benefit analysis given their risk of aggravating iron deficiency. In conclusion, this review summarizes the current ischemic stroke burden from PAVMs, the implicative pathophysiology, and relevant diagnostic and treatment overviews to facilitate future incorporation into AHA/ASA guidelines.

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Section: Pavm Etiology and Complicationsmentioning

confidence: 99%

“…Traumatic origin is reported but notably, in our experience, these are almost always misdiagnosed systemic-to-pulmonary artery communications. 32…”

Section: Pavm Etiology and Complicationsmentioning

confidence: 99%

Ischemic Stroke and Pulmonary Arteriovenous Malformations

et al. 2022

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“…Communication between the systemic artery and pulmonary artery (PA) in the absence of chronic lung disease is rare, and few reports have described this entity [1] , [2] , [3] , [4] . Although patients are occasionally asymptomatic, various complications, such as bacterial seeding, hemorrhage, PA hypertension, and congestive heart failure can occur [2] .…”

Section: Introductionmentioning

confidence: 99%

“…Although patients are occasionally asymptomatic, various complications, such as bacterial seeding, hemorrhage, PA hypertension, and congestive heart failure can occur [2] . Surgical management and endovascular embolization have been reported to be useful treatments [ 2 , 3 ]. Embolization of the feeding systemic artery is the most common endovascular embolization technique [ 1 , 2 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Chest wall systemic artery-to-pulmonary artery vascular malformation treated by embolization of feeders and drainers: A case report

Onishi

Yasumura

et al. 2022

Radiology Case Reports

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“…The systemic arteries became larger, as we could observe on the chest wall arteries (intercostal arteries, internal and external thoracic arteries, inferior diaphragmatic artery) and limited development of bronchial arteries. In the study by Alsafi et al, 3 authors managed their patients with transpleural anastomoses in a conservative approach as their patients were asymptomatic with a median follow-up of 4.5 years. In our case, because of our patient’s symptoms, therapeutic embolization was successfully performed.…”

mentioning

confidence: 99%