Document Detail


Diffuse pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia: long-term results of embolization according to the extent of lung involvement.
MedLine Citation:
PMID:  19118276     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To review the safety of embolization in patients affected with hereditary hemorrhagic telangiectasia (HHT) presenting with diffuse pulmonary arteriovenous malformations (PAVMs). To correlate the initial presentation and long-term results of embolization according to the distribution of PAVMs. MATERIALS AND METHODS: All consecutively treated patients were divided into three groups, according to the involvement of every subsegmental pulmonary artery (group 1), segmental artery (group 2), or both (group 3) of at least one lobe. Age, sex, initial clinical presentation, and Pao(2) were recorded before embolization. Per and postprocedural complications were carefully recorded. Clinical outcome and imaging follow-up were obtained at 6 months and annually thereafter. RESULTS: Thirty-nine patients (31 women, 8 men; mean age, 35 years), all of them with bilateral lung involvement, were treated. Group 1 consisted of 8, group 2 of 17, and group 3 of 14 patients. Dyspnea was present in 35 of the patients (90%) and cyanosis in 17 patients (44%). Preembolization Pao(2) was different between groups 1 (52.6 +/- 11.6 mm Hg) and 3 (70.7 +/- 14.1 mm Hg). Neurologic events were more frequently reported before treatment in group 1 (62.5%) than in group 2 (35%) or in group 3 (43%). Eighty percent of patients reported improvement in their dyspnea after embolization. Pao(2) levels improved more in group 2 than in groups 1 and 3. Eight ischemic or infectious complications occurred in 4 patients (10%) due to reperfusion of embolized PAVMs or enlargement of non-embolized PAVMs. Complete and partial treatment success was reported using CT scanning in 59% and 38% of cases, respectively. CONCLUSION: Dyspnea and paradoxical embolism are frequently encountered in HHT patients with diffuse PAVMs. Prevention of complications and improvement of dyspnea can be achieved after successful embolization in most patients. Better improvement of Pao(2) can be achieved in group 2.
Authors:
Pascal Lacombe; Christine Lagrange; Alain Beauchet; Mostafa El Hajjam; Thierry Chinet; Jean-Pierre Pelage
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Publication Detail:
Type:  Journal Article     Date:  2008-12-31
Journal Detail:
Title:  Chest     Volume:  135     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-07     Completed Date:  2009-04-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1031-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Radiology, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Université Paris Ile-de-France Ouest, 9 Ave. Charles de Gaulle, Boulogne-Billancourt Cedex, France.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Arteriovenous Malformations / radiography,  therapy*
Child
Dyspnea / etiology
Embolization, Therapeutic* / adverse effects,  methods
Female
Humans
Male
Middle Aged
Pulmonary Circulation*
Telangiectasia, Hereditary Hemorrhagic / complications*
Tomography, X-Ray Computed
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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