Pulmonary arteriovenous malformations in children: outcomes of transcatheter embolotherapy

Marie E Faughnan, Ashraf Thabet, Meir Mei-Zahav, Maria Colombo, Ian Maclusky, Robert H Hyland, Robyn A Pugash, Peter Chait, Katharine J Henderson, Robert I White
Journal of Pediatrics 2004, 145 (6): 826-31

OBJECTIVE: To describe outcomes of transcatheter embolotherapy (TCE) in children with pulmonary arteriovenous malformations (PAVMs).

STUDY DESIGN: Chart and imaging review of all children (age </=18 years) treated for PAVMs by TCE at three hereditary hemorrhagic telangiectasia centers.

RESULTS: All 42 treated patients were included, with a mean age of 12 years (range, 4 to 18). Cyanosis was present in 25 of 42 patients (60%). Hemoptysis had occurred in 3 of 42 patients (7%) and neurologic complications (stroke, cerebral abscess) occurred in 8 patients (19%) before assessment. PAVMs were focal in 30 of 42 (71%) and diffuse in 12 of 42 (29%) patients. TCE was performed for 172 PAVMs and 35 diffuse regions (regional TCE). Follow-up was obtained in 38 of 42 (90%) patients (mean, 7 years). After TCE in patients with focal PAVMs, oxygenation improved significantly, with no further complications from the PAVMs. Reperfusion was noted in 23 of 153 (15%) PAVMs. Eighteen of 23 (78 %) of these were retreated, with documented aneurysmal involution in 10 of 13 (77%) patients. TCE complications included pleuritic chest pain (24% of sessions) and deployment complications (device paradoxical embolization or device misplacement) (3% of sessions, 1% of PAVMs), with no long-term complications.

CONCLUSIONS: PAVMs cause life-threatening complications in children; treatment with TCE is safe, with complication rates comparable to adult rates.

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