Surgical resection of diffuse pulmonary arteriovenous malformations (PAVMs).

Objective: Patients with pulmonary arteriovenous malformations (PAVM) can have significant morbidity and mortality. Surgical resection in isolation or with embolization is reported to treat diffuse-type PAVMs. Herein, we describe outcomes for children and adults for whom PAVMs were managed with elective surgical resection.

Methods: This retrospective analysis includes all patients treated with surgical resection for PAVM from August 1, 2009, to July 20, 2023. Demographic, diagnostic, treatment, and follow-up information were abstracted from medical records. Descriptive statistics were used.

Results: Among 18 patients who underwent surgical resection of PAVMs, 12 had hereditary hemorrhagic telangiectasia. Primary indications for surgery included hemoptysis (n = 4), dyspnea (n = 8), persistence of PAVM following embolotherapy (n = 5), and stroke (n = 1). Selected PAVMs were diffuse-type (n = 14) or highly complex (n = 4). Eight patients underwent embolotherapy before surgery. Most resections were performed via thoracotomy (16/18), with 2 video-assisted thoracoscopic surgeries. Resection consisted of lobectomy (n = 14), segmentectomy (n = 3), or pneumectomy (n = 1). Median oxygen saturation improved from 90% preoperatively to 97% postoperatively. The majority (17/18) of patients were extubated in the operating room, with no major complications. The median hospital length of stay was 4.5 days (range, 2-9 days), with a median of 1 intensive care unit day (range, 1-5 days). At median follow-up of 16 months (range, 6 months-12.1 years), median oxygen saturation was 98%, no bleeding recurred, and 100% survived.

Conclusions: Although embolization has been the main therapy for most PAVMs, surgical resection of diffuse-type PAVMs is safe and effective. Outcomes were excellent with improvement of oxygen saturation and functional status.