Pınar BIÇAKÇIOĞLU, Nurettin KARAOĞLANOĞLU, Yetkin AĞAÇKIRAN, Sadi KAYA, Selim Şakir Erkmen GÜLHAN, Ebru SAYILIR, Hakan ERTÜRK

Surgical treatment of pulmonary arteriovenous malformations

Background/aim: Pulmonary arteriovenous malformations (PAVMs) are direct communications between the branches of pulmonary arteries and veins. This study evaluates surgically treated cases of pulmonary arteriovenous malformations. Materials and methods: We retrospectively examined 41 cases of PAVM that were operated in our clinic between 1995 and 2012. We obtained the clinical, radiological, and surgical data of the patients from their files. Results: The 41 cases comprised 27 males and 14 females. Their mean age at diagnosis was 39.8 years (range: 9 71). The symptoms were hemoptysis in 28 cases, dyspnea in five, cough in three, and epistaxis in two; three patients were asymptomatic. Twenty-three right and 19 left posterolateral thoracotomies were performed, including one case which was operated bilaterally. Lower lobectomy was performed in 17 patients, lower lobectomy and lingulectomy in two, upper lobectomy in ten, middle lobectomy in two, segmentectomy in seven, and wedge resection in four. Postoperative histopathology was arteriovenous malformation in all cases. Conclusion: PAVMs are rare clinical conditions. Surgery remains the first choice when embolization treatment cannot be performed or is not successful, in symptomatic and complicated patients with PAVM, and/or in cases where the PAVM diagnosis cannot be established.

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1. Khurshid I, Downie GH. Pulmonary arteriovenous malformation. Postgrad Med J 2002; 78: 191-197.
2. Churton T. Multiple aneurysms of pulmonary artery. BMJ 1897; 1: 1223.
3. Gossage JR, Kanj G. Pulmonary arteriovenous malformations. Am J Respir Crit Care Med 1998; 158: 643-661.
4. Hepburn J, Dauphinee JA. Successful removal of hemangioma of lung followed by disappearance of polycythemia. Am J Med Sci 1942; 204: 681-687.
5. Swanson KL, Prakash UBS, Stanson AW. Pulmonary arteriovenous fistulas: Mayo Clinic experience, 1982-1997. Mayo Clin Proc 1999; 74: 671-680.
6. Nakayama M, Nawa T, Chonan T, Endo K, Morikawa S, Bando M, Wada Y, Shioya T, Sugiyma Y, Fukai S. Prevalence of pulmonary arteriovenous malformations as estimated by lowdose thoracic CT screening. Internal Med 2012; 51: 1677-1681.
7. Pick A, Deschamps C, Stanson A. Pulmonary arteriovenous fistula: presentation, diagnosis, and treatment. World J Surg 1999; 23: 1118-1122.
8. Fraga JC, Favero E, Contelli F, Canani F. Surgical treatment of congenital pulmonary arteriovenous fistula in children. J Ped Surg 2008; 43: 1365-1367.
9. Plauchu H, de Chadarevian JP, Bideau A, Robert JM. Agerelated clinical profile of hereditary hemorrhagic telangiectasia in an epidemiologically recruited population. Am J Med Genet 1989; 32: 291-297.
10. Meek ME, Meek JC, Beheshti MV. Management of pulmonary arteriovenous malformations. Semin Intervent Radiol 2011; 28; 24-31.
11. Frence BA, Shannon TM, White RI Jr, Zawin M, Burdge CM. Life-threatening pulmonary hemorrhage with pulmonary arteriovenous malformations and hereditary hemorrhagic telangiectasia. Chest 1994; 106: 1387-1390.
12. Liptay MJ, Ujiki MB. Congenital vascular lesions of the lungs. In: Shields TW, LoCicero J 3rd, Ponn RB, Rush VW, eds. General Thoracic Surgery. 6th ed. Philadelphia, PA, USA: Lippincott Williams and Wilkins; 2005. pp. 1142-1156.
13. Wong HH, Chan RP, Faughnan ME. Idiopathic pulmonary arteriovenous malformations: clinical and imaging characteristics. Eur Respir J 2011; 38: 368-375.
14. Remy J, Remy-Jardin M, Giraud F, Wattinne L. Angioarchitecture of pulmonary arteriovenous malformations: clinical utility of three-dimensional helical CT. Radiology 1994; 191: 657-664.
15. Zhang SY, Zhang ZT, Ou SL, Hu YS, Song FQ, Li X, Ma XC, Ma XX, Liang L, Li D et al. Fistulectomy as a surgical option for pulmonary arteriovenous malformation. Chin Med J 2009; 122: 2321-2234.
16. Kong JH, Oh TY, Kim JT, Baek KS, Chang WH. Transcatheter embolization of giant pulmonary arteriovenous malformation with an Amplatzer vascular plug II. Korean J Thorac Cardiovasc Surg 2012; 45: 326-329.
17. White RI, Pollak JS, Wirth JA. Pulmonary arteriovenous malformations: diagnosis and transcatheter embolotherapy. J Vasc Intervent Radiol 1996; 7: 787-804.