Clinical Significance of Pulmonary Arteriovenous Malformation Reperfusion

The purpose of this study was to assess the clinical significance of reperfused pulmonary arteriovenous malformations (rPAVM) after embolization. This study is a retrospective review of all patients from a single HHT center who underwent pulmonary arteriovenous malformation (PAVM) embolization between January 1, 2006 and December 30, 2007. Clinical history, imaging findings (including reperfusion), and symptoms seen in the setting of PAVMs were reviewed both at the time of embolization and during the subsequent follow-up through December 30, 2013. During the 2-year treatment period, 101 patients underwent PAVM embolization. During the initial embolization, 27 patients were found to have reperfusion of a previously embolized PAVM. During the follow-up period, none of these patients had recurrence of the rPAVM. Three patients who underwent an embolization procedure for the first time at the initial procedure were subsequently found to have rPAVM during the follow-up period. This resulted in a total of 30 patients with rPAVMs. Eighteen (60%) of the 30 patients were found to be symptomatic at the time of presentation with rPAVM. However, 14 had at least one other significant PAVM at the time of diagnosis of reperfusion. Only two symptomatic patients had only rPAVM, both with mild manifestations. Two patients were excluded from the study as their symptoms were attributed to other medical comorbidities. The majority of symptomatic patients with rPAVM had additional PAVMs that required embolization. Neither of the symptomatic patients with an isolated rPAVM had severe manifestations.