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


METHODS
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.
Faughnan
Marie E
ME
Department of Medicine, Division of Respiratory Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. faughnanm@smh.toronto.on.ca
Thabet
Ashraf
A
Mei-Zahav
Meir
M
Colombo
Maria
M
Maclusky
Ian
I
Hyland
Robert H
RH
Pugash
Robyn A
RA
Chait
Peter
P
Henderson
Katharine J
KJ
White
Robert I
RI
D000293:Adolescent; D001165:Arteriovenous Malformations / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome