Bakhos Charles T, Wang Stephani C, Rosen Jonathan M
Albany Medical Center, Division of Cardiothoracic Surgery, Department of Surgery, Albany, NY 12208, USA.
J Thorac Dis. 2016 Jan;8(1):195-7. doi: 10.3978/j.issn.2072-1439.2015.12.67.
Pulmonary arteriovenous malformations (PAVM) can have potentially serious neurological and cardiac consequences if left untreated. Embolization has supplanted surgical resection as the first line treatment modality. However, this technique is not always successful and carries risks of air embolism, migration of the coil, myocardial rupture, vascular injury, pulmonary hypertension, and pulmonary infarction. We present two patients with symptomatic PAVM despite multiple embolizations: the first one with recurrent and persistent hemoptysis who underwent a thoracoscopic lobectomy, and the second one with chronic debilitating pleuritic pain subsequent to embolization who underwent a thoracoscopic wedge resection. Video-assisted thoracoscopic surgery (VATS) with lung resection was successfully performed in both patients, with complete resolution of their symptoms. We also review the literature regarding the contemporary role of surgery in PAVM, particularly thoracoscopy.
肺动静脉畸形（PAVM）若不治疗可能会导致严重的神经和心脏后果。栓塞术已取代手术切除成为一线治疗方式。然而，该技术并非总是成功，且存在空气栓塞、线圈移位、心肌破裂、血管损伤、肺动脉高压和肺梗死等风险。我们报告了两名尽管多次栓塞仍有症状性PAVM的患者：第一名患者反复持续性咯血，接受了胸腔镜肺叶切除术；第二名患者栓塞后出现慢性衰弱性胸膜炎性疼痛，接受了胸腔镜楔形切除术。两名患者均成功进行了电视辅助胸腔镜手术（VATS）及肺切除术，症状完全缓解。我们还回顾了关于手术在PAVM中的当代作用，特别是胸腔镜手术的文献。
