What Are PAVMS?

Pulmonary arteriovenous malformations (PAVMs) are developmental anomalies involving the arteries going to the lungs and the veins returning from the lungs. The anomaly is a direct communication between the artery and vein, instead of the normal capillary bed. As the blood flows through this communication with no resistance, these communications can expand and dilate (turn into aneurysms). In addition, when these communications are present, anything that is in the venous system can freely cross over to the arterial system. The lungs normally act as a filter to prevent this from happening. When this filter is absent, blood clots, bacteria, even air can cross this communication and can result in a stroke, brain abscess, or other issues.

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Hereditary Hemorrhagic Telangiectasia Treatment Center

Hereditary Hemorrhagic Telangiectasia (HHT) a genetic condition that predisposes patients to develop PAVMs. There are often multiple other issues that can develop in HHT patients and it’s best to be seen in a multidisciplinary clinic that focuses on these problems.

Fortunately, here in Indianapolis, we have an HHT Treatment Center, and hopefully soon a Center of Excellence, located at the Indiana Hemophilia and Thrombosis Center (IHTC). We have had the opportunity to treat all of their PAVM patients over the years and work closely with their team to develop appropriate treatment plans.

Treatment for PAVMS

We typically recommend treatment for PAVMs when they are symptomatic and or when the feeding vessel measures > 3mm. Patients can experience shortness of breath, stroke, brain abscess, recurrent migraine or hypoxia. (low oxygen level)

PAVMs are treated via a minimally invasive procedure where a small catheter (tube about the diameter of a piece of spaghetti) is inserted into the vein (common femoral vein) in the right groin. This catheter is manipulated through the heart and into the pulmonary artery (artery going out to the lungs). From here, the abnormal communication is identified by injecting contrast into the different branches of the pulmonary artery. Once the PAVM is identified, it is embolized (turned off/plugged) using a variety of different devices.

After the PAVM is embolized successfully, the catheter is removed from the groin and light pressure is applied for several minutes to ensure no bleeding. You will have between 1-2hrs of bedrest and will then be allowed to go home.

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Treatment process

Recovery

There are typically no major symptoms from the closure of the PAVM. Occasionally, one may experience a small bruise in the groin, and a small amount of chest pain when taking in a deep breath, but this usually only lasts <24hrs.

Risks

This is a minimally invasive procedure, but it does have risks. These risks are similar to not treating the PAVM and include stroke, infection, and arterial embolism, but are all very rare. The most common issue is a bruise in the groin.

If you have HHT or PAVMs and would like to be evaluated for treatment please call our clinical coordinators at 317-328-7255.

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