Surgical resection of diffuse pulmonary arteriovenous malformations (PAVMs)

Abstract

Objective

Patients with pulmonary arteriovenous malformations (PAVM) can have significant morbidity and mortality. Surgical resection in isolation or with embolization is reported to treat diffuse-type PAVMs. Herein, we describe outcomes for children and adults for whom PAVMs were managed with elective surgical resection.

Methods

This retrospective analysis includes all patients treated with surgical resection for PAVM from August 1, 2009, to July 20, 2023. Demographic, diagnostic, treatment, and follow-up information were abstracted from medical records. Descriptive statistics were used.

Results

Among 18 patients who underwent surgical resection of PAVMs, 12 had hereditary hemorrhagic telangiectasia. Primary indications for surgery included hemoptysis (n = 4), dyspnea (n = 8), persistence of PAVM following embolotherapy (n = 5), and stroke (n = 1). Selected PAVMs were diffuse-type (n = 14) or highly complex (n = 4). Eight patients underwent embolotherapy before surgery. Most resections were performed via thoracotomy (16/18), with 2 video-assisted thoracoscopic surgeries. Resection consisted of lobectomy (n = 14), segmentectomy (n = 3), or pneumectomy (n = 1). Median oxygen saturation improved from 90% preoperatively to 97% postoperatively. The majority (17/18) of patients were extubated in the operating room, with no major complications. The median hospital length of stay was 4.5 days (range, 2-9 days), with a median of 1 intensive care unit day (range, 1-5 days). At median follow-up of 16 months (range, 6 months-12.1 years), median oxygen saturation was 98%, no bleeding recurred, and 100% survived.

Conclusions

Although embolization has been the main therapy for most PAVMs, surgical resection of diffuse-type PAVMs is safe and effective. Outcomes were excellent with improvement of oxygen saturation and functional status.