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Diffuse Pulmonary Arteriovenous Malformations^*

Characteristics and Prognosis

^* From the Division of Respiratory Medicine, Department of Medicine (Drs. Faughnan and Hyland), and the Department of Medical Imaging (Dr. Pugash), St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada; the Department of Diagnostic and Interventional Radiology (Drs. Lui and White), Yale University School of Medicine, New Haven, CT; the Division of Pulmonary Medicine (Dr. Wirth), Maine Medical Center, Portland, ME; and Department of Medicine, Sunnybrook Health Sciences Centre (Dr. Redelmeier), University of Toronto, Toronto, Canada.

Correspondence to: Robert H. Hyland, MD, FCCP, St. Michael’s Hospital, 30 Bond St, Toronto, Canada, M5B1W8; e-mail: hylandb{at}smh.toronto.on.ca

Objective: To study the clinical characteristics and prognosis of patients with diffuse pulmonary arteriovenous malformations (AVMs).

Design: Retrospective chart review of all patients (n = 16) with diffuse pulmonary AVMs seen at Yale New Haven Hospital, Johns Hopkins Hospital, and St. Michael’s Hospital. Up-to-date follow-up information was obtained in all living patients.

Results: All patients were severely hypoxic. Neurologic complications (stroke or brain abscess) had occurred in 70% of patients by the time of diagnosis. During the follow-up period (mean, 6 years), three patients died and two others developed new neurologic complications. One of the deaths occurred perioperatively during lung transplantation. All patients underwent transcatheter embolotherapy of any large pulmonary AVMs. A selected group underwent pulmonary flow redistribution, a novel technique. Oxygenation did not improve significantly with embolotherapy of the larger AVMs, but there was a small significant improvement in those patients who underwent pulmonary flow redistribution. The majority (85%) of the living patients are currently working or studying full-time.

Conclusions: Patients with diffuse pulmonary AVMs are at increased risk of neurologic complications. Transcatheter embolotherapy does not significantly improve the profound hypoxia, but it may reduce the risk of neurologic complications. Antibiotic prophylaxis is recommended for bacteremic procedures to prevent brain abscess. These patients can live for many years and lead productive lives. We do not recommend lung transplantation because survival with disease is difficult to predict and we have observed a perioperative transplant death.

Key Words: arteriovenous malformation • brain abscess • hereditary hemorrhagic telangiectasia • pulmonary • telangiectasia

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