Embolotherapy of Large Pulmonary Arteriovenous Malformations: Long-Term Results

Lee, Daniel W.; White, Robert I.; Egglin, Thomas K.; Pollak, Jeffrey; Fayad, Pierre; Wirth, Joel A.; Rosenblatt, Melvin; Dickey, Kevin W.; Burdge, Catherine M.

doi:10.1016/s0003-4975(97)00815-1

Cited by 284 publications

(257 citation statements)

References 11 publications

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“…(57) Only 25-50% of patients with AVM present with signs and symptoms, which include cyanosis, digital clubbing, dyspnea, fatigue, and polycythemia. (53)(54)(55)(56)(57)(58) Males and females are equally likely to have an AVM. (55) Of all patients with AVM, 8-20% present with bilateral AVM, and 33-50% present with multiple AVMs, (55)(56)(57) the incidence being higher in the middle and left lower lobes ( Figure 5).…”

Section: Avmmentioning

confidence: 99%

“…(54,57) Complications of AVMs are related to connections of the pulmonary capillary bed, with loss of the filtering function of the lung; this allows emboli and bacteria to directly exit the systemic circulation, which results in embolism or brain abscesses. (53,54,57,58) It can also result in bleeding of these abnormal vessels, leading to hemoptysis or hemothorax. (54) The most common presentation of AVM is an abnormal and direct communication between pulmonary arteries and veins through small aneurysms, (53,58) in which right-to-left shunt occurs, although normal cardiac function is maintained in most cases.…”

Section: Avmmentioning

confidence: 99%

“…(53,54,57,58) It can also result in bleeding of these abnormal vessels, leading to hemoptysis or hemothorax. (54) The most common presentation of AVM is an abnormal and direct communication between pulmonary arteries and veins through small aneurysms, (53,58) in which right-to-left shunt occurs, although normal cardiac function is maintained in most cases. As children with AVM grow, they present with decreased oxygen saturation and polycythemia.…”

Section: Avmmentioning

confidence: 99%

“…(53,56,58) The treatment of choice for AVM is conservative lung resection; when the AVM is peripheral, wedge resection is the preferred procedure, whereas large lesions might require lobectomy or pneumonectomy, (53)(54)(55)57,59) embolization being reserved for patients in whom the surgical treatment is contraindicated or for those with multiple lesions. (53,57,58) Embolization yields excellent initial results, and resolution is achieved in 80-100% of cases; however, embolization has a high recurrence rate. (53,54,57) There have been reports of lung transplantation as a form of treatment for diffuse AVMs.…”

Section: Avmmentioning

confidence: 99%

“…(53,54,57) The differential diagnoses of AVMs include CCAM, bronchial atresia, pulmonary sequestration, cystic neoplasms, bronchogenic cysts, and esophageal duplications. (56) The treatment of AVM has three basic objectives (53,57,58) : improvement of the symptoms Congenital lung malformations diagnosis of congenital lung malformations in the postnatal period, whereas obstetric ultrasound is considered an excellent method for diagnosing congenital lung malformations in the prenatal period.…”

Section: Final Considerationsmentioning

confidence: 99%

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Malformações pulmonares congênitas

2011

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Congenital lung malformations are rare and vary widely in their clinical presentation and severity, depending mostly on the degree of lung involvement and their location in the thoracic cavity. They can manifest at any age and can be the source of significant morbidity and mortality in infants and children. Individuals with congenital lung malformations can present with respiratory symptoms at birth or can remain asymptomatic for long periods. Recently, there has been an increase in the early diagnosis of these malformations, a change that is attributable to the routine use of prenatal ultrasound. The clinical manifestation of these malformations varies from respiratory distress in the immediate postnatal period to an incidental finding on chest X-rays. Early diagnosis and prompt treatment offer the possibility of absolutely normal lung development. The treatment of asymptomatic patients with lung malformations is controversial, because the prognosis of these diseases is unpredictable. The management of these lesions depends on the type of malformation and symptoms. Because of the risk of complications, most authors recommend resection of the lesion at the time of diagnosis. Lobectomy is the procedure of choice and yields excellent long-term results. This article describes the principal congenital lung malformations, their diagnosis, and the controversies regarding treatment.Keywords: Cystic adenomatoid malformation of lung, congenital; Bronchopulmonary sequestration; Pulmonary surgical procedures; Diagnosis. ResumoAs malformações congênitas do pulmão são raras e variam muito na sua forma de apresentação clínica e gravidade, dependendo principalmente do grau de envolvimento pulmonar e de sua localização na cavidade torácica. Elas podem se manifestar em qualquer idade e podem ser fonte de importante morbidade e mortalidade em lactentes e crianças. Os indivíduos com malformações congênitas do pulmão podem apresentar sintomas respiratórios ao nascimento, enquanto outros podem permanecer assintomáticos por longos períodos. Atualmente, com o uso rotineiro da ultrassonografia pré-natal, vem ocorrendo um aumento no diagnóstico mais precoce dessas malformações. A manifestação clínica dessas malformações varia desde uma disfunção respiratória pós-natal imediata a um achado acidental na radiografia de tórax. O diagnóstico precoce e o tratamento imediato oferecem a possibilidade de um desenvolvimento pulmonar absolutamente normal. Quando assintomáticos, a conduta para o tratamento dos pacientes com malformações pulmonares ainda é controversa, uma vez que o prognóstico dessas afecções é imprevisível. O manejo dessas lesões depende do tipo de malformação e de sintomas. Devido ao risco de complicação, a maioria dos autores sugere a ressecção da lesão no momento em que essa é identificada. A lobectomia é o procedimento de escolha, fornecendo excelentes resultados a longo prazo. Este artigo descreve as principais malformações pulmonares congênitas, seu diagnóstico e controvérsias quanto o tratamento. (5) is covered by ...

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Section: Avmmentioning

confidence: 99%

Section: Avmmentioning

confidence: 99%

Section: Avmmentioning

confidence: 99%

Section: Avmmentioning

confidence: 99%

Section: Final Considerationsmentioning

confidence: 99%

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Malformações pulmonares congênitas

2011

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Symptomatic Children With Hereditary Hemorrhagic Telangiectasia

Mei-Zahav¹,

Letarte²,

Faughnan³

et al. 2006

Arch Pediatr Adolesc Med

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Embolisation therapy for pulmonary arteriovenous malformations

Hsu¹,

Kwan²,

Thompson³

et al. 2009

Cochrane Database of Systematic Reviews

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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.

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Embolotherapy of Large Pulmonary Arteriovenous Malformations: Long-Term Results

Cited by 284 publications

References 11 publications

Malformações pulmonares congênitas

Malformações pulmonares congênitas

Symptomatic Children With Hereditary Hemorrhagic Telangiectasia

Embolisation therapy for pulmonary arteriovenous malformations

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