Embolisation therapy for pulmonary arteriovenous malformations

Abstract

Background Pulmonary arteriovenous malformations are abnormal direct connections between the pulmonary artery and pulmonary vein which result in a right-to-left shunt. They are associated with substantial morbidity and mortality mainly from the effects of paradoxical emboli. Potential complications include stroke, cerebral abscess, pulmonary haemorrhage and hypoxaemia. Embolisation therapy is a form of treatment based on the occlusion of the feeding arteries to a pulmonary arteriovenous malformation and can prevent many of these debilitating and life-threatening complications. Objectives To determine the efficacy and safety of embolisation therapy in people with pulmonary arteriovenous malformations including a comparison with surgical resection and different embolisation devices. Search methods We searched the Cystic Fibrosis and Genetic Disorders Group's Trials Registers (last searched 07 September 2009). We also searched the following databases: the Australian New Zealand Clinical Trials Registry; ClinicalTrials.gov; International Standard Randomised Controlled Trial Number Register; International Clinical Trials Registry Platform Search Portal (last searched 22 November 2009). We checked cross-references and searched references from review articles. Finally, we contacted manufacturers and specialised centres for unpublished and ongoing trials. Selection criteria Trials in which individuals with pulmonary arteriovenous malformations were randomly allocated to embolisation therapy compared to no treatment, surgical resection or a different embolisation device. Studies identified for potential inclusion were independently assessed for eligibility by two authors, with excluded studies further checked by a third author. Data collection and analysis No trials were identified. As this was the case, no analysis was performed. Main results There were no randomised controlled trials identified.

Case report: video-assisted thoracoscopic surgery for pulmonary arteriovenous malformation using near-infrared fluorescence with indocyanine green

“…Despite being less invasive, it bears the risk of recanalization and accidental systemic embolism. According to a systematic review of the Cochrane database, no randomized controlled trials (RCTs) have proven PTE to be the mainstream treatment for PAVMs [ 13 ]. Moreover, some vascular mimickers of PAVMs require surgical resection [ 14 ].…”

Case Report: Video-Assisted Thoracoscopic Surgery for Pulmonary Arteriovenous Malformation Using Near-Infrared Fluorescence with Indocyanine Green

“…Despite being less invasive, it bears the risk of recanalization and accidental systemic embolism. According to a systematic review of the Cochrane database, no RCTs have proven PTE to be the mainstream treatment for PAVMs [9]. Moreover, some vascular mimickers of PAVMs require surgical resection [10].…”

Lung Shadow in Neonate: An Unusual and Treatable Cause of Cyanosis

“…Symptomatology depends upon the extent of the disease. In the current scenario, recommendations suggest that all PAVMs should be treated with embolisation therapy and that surgery is to be reserved for individuals with PAVMs that are not amenable to embolisation or have other contraindications to embolisation, such as an allergy to contrast material [5]. Surgical options like ligation of fistula, Segmental resection or lobectomy are more invasive and more morbid.…”