pulmonary AVM

Question 1

preprocedural steps before pulmonary AVM procedure

Answer 1

1. EKG - to look for Left heart block (since you are going through the right heart for the procedure)
2. antibiotics
3. anticoagulation with heparin to prevent pericatheter thrombus
4. air embolism risk (bubble filter IVs or blood filters)

Question 2

should pulmonary AVMs less than 3 mm be treated

Answer 2

yes

Question 3

what is the technique used to embolize pAVMs known as

Answer 3

anchor technique

Question 4

common side effect of pAVM embolisation

Answer 4

pleurisy

Question 5

what pattern of inheritance is HHT

Answer 5

autosomal dominant

Question 6

what criteria are used to diagnose HHT

Answer 6

The Curaçao criteria

1. Epistaxis (Nosebleeds): Frequent, spontaneous nosebleeds that start in childhood or adolescence.
2. Telangiectasia: Presence of multiple telangiectasiason mucous membranes (e.g., inside the mouth) or skin
3. Arteriovenous Malformations (AVMs): in organs such as the lungs, liver, brain, or GI
4. Family History: A family history of HHT or a diagnosis of HHT in a close relative.

To diagnose HHT, a patient usually needs to meet at least three of these criteria. If a person meets two of the criteria, a genetic test or further clinical evaluation may be recommended to confirm the diagnosis.

Question 7

what percentage of adults with HHT have epistaxis

Answer 7

90%

Question 8

what percentage range of patients with a solitary pAVM have HHT

Answer 8

65-90%

Question 9

what are the symptoms of paradoxical emboli 2/2 pAVM

Answer 9

1. migraine
2. TIA/Stroke
3. brain abscess

Question 10

what percentage range of pAVMs are simple

Answer 10

80-90%

Question 11

does anyone know the growth rate of pAVMs

Answer 11

NO

Question 12

what is the diagnostic imaging modality used for screening for pAVM

Answer 12

contrast echocardiogram

Question 13

what lifelong precautions are needed for patients with pAVMs

Answer 13

antibiotic prophylaxis for any procedures (including dental) and air embolism/bubble precautions

Question 14

does paradoxical embolization depend on the size of a pAVM feeding artery

Answer 14

no, it can happen with any feeding artery diameter, even less than 3 mm

Shovlin CL, Jackson JE, Bamford KB, et al. Pri-mary determinants of ischaemic stroke/brain ab-scess risks are independent of severity of pulmo-nary arteriovenous malformations in hereditaryhaemorrhagic telangiectasia. Thorax 2008; 63:259–266

Question 15

what are the predictors of recanalization and reperfusion of a pAMV

Answer 15

1. embolization more than 1 cm from the sacn
2. single coils used for embolization
3. coil oversizing (not getting a good packing)
4. large feeding arteries

Question 16

if an amplatzer plug is used to embolize a pAVM feeding artery, what can be done to decrease the risk of recanalization

Answer 16

placing a coil behind it

Question 17

when is imaging obtained after pAVM embolization

Answer 17

6 months after
then 3-5 years if sac involution occurs