Hsu Charlie C-T, Kwan Gigi N C, Thompson Shane A, Evans-Barns Hannah, van Driel Mieke L
Department of Medical Imaging, Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Queensland, Australia, 4102.
Cochrane Database Syst Rev. 2015 Jan 29;1:CD008017. doi: 10.1002/14651858.CD008017.pub4.
Pulmonary arteriovenous malformations are abnormal direct connections between the pulmonary artery and pulmonary vein which result in a right-to-left shunt. They are associated with substantial morbidity and mortality mainly from the effects of paradoxical emboli. Potential complications include stroke, cerebral abscess, pulmonary haemorrhage and hypoxaemia. Embolisation is an endovascular intervention based on the occlusion of the feeding arteries the pulmonary arteriovenous malformations thus eliminating the abnormal right-to-left-shunting.
To determine the efficacy and safety of embolisation in patients with pulmonary arteriovenous malformations including a comparison with surgical resection and different embolisation devices.
We searched the Cystic Fibrosis and Genetic Disorders Group's Trials Register; date of last search: 31 March 2014.We also searched the following databases: the Australian New Zealand Clinical Trials Registry; ClinicalTrials.gov; International Standard Randomised Controlled Trial Number Register; International Clinical Trials Registry Platform Search Portal (last searched 1 July 2014).We checked cross-references and searched references from review articles.
Trials in which individuals with pulmonary arteriovenous malformations were randomly allocated to embolisation compared to no treatment, surgical resection or embolisation using a different embolisation device.
Studies identified for potential inclusion were independently assessed for eligibility by two authors, with excluded studies further checked by a third author. No trials were identified for inclusion in the review and hence no analysis was performed.
There were no randomised controlled trials included in the review; one ongoing trial has been identified which may be eligible for inclusion in the future.
AUTHORS' CONCLUSIONS: There is no evidence from randomised controlled trials for embolisation of pulmonary arteriovenous malformations. However, randomised controlled trials are not always feasible on ethical grounds. Accumulated data from observational studies suggest that embolisation reduces morbidity. A standardised approach to reporting with long-term follow-up through registry studies can help to strengthen the evidence for embolisation in the absence of randomised controlled trials.
肺动静脉畸形是肺动脉与肺静脉之间异常的直接连接，可导致右向左分流。它们与主要由反常栓塞效应引起的显著发病率和死亡率相关。潜在并发症包括中风、脑脓肿、肺出血和低氧血症。栓塞是一种基于闭塞肺动静脉畸形供血动脉的血管内介入治疗，从而消除异常的右向左分流。
确定栓塞治疗肺动静脉畸形患者的疗效和安全性，包括与手术切除及不同栓塞装置的比较。
我们检索了囊性纤维化和遗传疾病组试验注册库；最后检索日期：2014年3月31日。我们还检索了以下数据库：澳大利亚新西兰临床试验注册库；ClinicalTrials.gov；国际标准随机对照试验编号注册库；国际临床试验注册平台搜索门户（最后检索日期：2014年7月1日）。我们检查了交叉引用并检索了综述文章的参考文献。
将肺动静脉畸形患者随机分配接受栓塞治疗与不治疗、手术切除或使用不同栓塞装置进行栓塞治疗的试验。
两位作者独立评估潜在纳入研究的 eligibility，被排除的研究由第三位作者进一步检查。未识别出纳入综述的试验，因此未进行分析。
综述中未纳入随机对照试验；已识别出一项正在进行的试验，未来可能符合纳入标准。
随机对照试验中没有证据支持肺动静脉畸形的栓塞治疗。然而，基于伦理原因，随机对照试验并不总是可行的。观察性研究积累的数据表明栓塞可降低发病率。通过注册研究进行长期随访的标准化报告方法有助于在缺乏随机对照试验的情况下加强栓塞治疗的证据。
