Al-Sahaf May, Anderson Jon, Nandi Jayanta, Alsafi Ali, Shovlin Claire L
Department of Cardiothoracic Surgery Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK.
National Heart and Lung Institute, Imperial College London UK.
Pulm Circ. 2025 Jan 7;15(1):e70037. doi: 10.1002/pul2.70037. eCollection 2025 Jan.
Pulmonary arteriovenous malformations (PAVMs) cause cerebral abscess and ischemic stroke due to paradoxical emboli, risks that are increasingly recognized. We report the evolving placement of thoracic surgery in multi-disciplinary team management of PAVMs that were sporadic or associated with hereditary hemorrhagic telangiectasia. From 1983 to 2006, all patients receiving elective treatment had embolization. Between January 2006 and July 2022, 24 of 714 (3%) patients reviewed at our institution underwent elective surgical resection of one or more PAVMs. Initially, the bar for elective surgery had been set very high, and only patients with persistent symptoms of cerebral ischemia after maximal embolization and medical therapy were referred. As PAVM natural history, follow-up radiation exposures for residual PAVMs, and good surgical outcomes were appreciated, PAVM resection became part of the discussion for highly localized, very complex PAVMs which we consider are best treated surgically. Elective surgical intervention may be considered for other selected patients.
肺动静脉畸形（PAVM）可因反常栓塞导致脑脓肿和缺血性中风，这些风险日益受到关注。我们报告了胸外科手术在散发性或与遗传性出血性毛细血管扩张症相关的PAVM多学科团队管理中的角色演变。1983年至2006年，所有接受择期治疗的患者均接受了栓塞治疗。2006年1月至2022年7月，在我们机构接受评估的714例患者中有24例（3%）接受了一个或多个PAVM的择期手术切除。最初，择期手术的标准定得非常高，只有在最大程度栓塞和药物治疗后仍有持续性脑缺血症状的患者才会被转诊。随着对PAVM自然病史、残余PAVM的后续辐射暴露以及良好手术结果的认识，PAVM切除术成为了高度局限性、非常复杂的PAVM治疗讨论的一部分，我们认为这些PAVM最好通过手术治疗。对于其他选定的患者，可考虑进行择期手术干预。
