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      Successful treatment of multiple pulmonary arteriovenous fistulae with thoracoscopy

      case-report

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          Abstract

          Congenital pulmonary arteriovenous fistulae occur as a result of abnormal blood vessel development in the lungs. Blood takes a short pass from the pulmonary artery to veins. Multiple pulmonary arteriovenous fistulae are a rare occurrence, especially when involving both lungs. Fistulae located at the edge are prone to rupture and bleeding. We discuss a case of a 15‐year‐old overweight male with multiple pulmonary arteriovenous fistulae successfully treated with wedge‐shape excision via video‐assisted thoracoscopic surgery.

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          Most cited references20

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          Embolization of pulmonary arteriovenous malformations with amplatzer vascular plugs: safety and midterm effectiveness.

          To evaluate the safety and effectiveness of Amplatzer vascular plugs (AVPs) for percutaneous closure of arteries feeding pulmonary arteriovenous malformations (PAVMs).
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            Pulmonary arteriovenous malformations: evaluation with CT of the chest before and after treatment.

            A total of 109 single or multiple pulmonary arteriovenous malformations (PAVMs) were evaluated with computed tomography (CT) of the chest in 40 patients separated into three groups to study the usefulness of CT (a) in the diagnosis and pretherapeutic management of PAVMs by comparison with selective pulmonary angiography of each lung (group 1: 20 patients), (b) in the follow-up of patients who received treatment (group 2: 27 patients), and (c) as an isolated diagnostic procedure in elderly patients (n = 3) or family members with Osler-Weber-Rendu disease (n = 8) (group 3: 11 patients). Follow-up ranged from several weeks to 10 years (mean follow-up, 4 years). In group 1, conventional and dynamic CT enabled identification of 107 PAVMs (98.2%) (vs 65 PAVMs [59.6%] identified with angiography), with confident segmental location in 56 of 65 PAVMs (86%) and reliable analysis of angioarchitecture in 17 PAVMs (26%) (vs 39 PAVMs [60%] analyzed with angiography). In group 2, progressive aneurysmal retraction was associated with successful occlusion. In group 3, CT enabled noninvasive evaluation of patients unable to undergo treatment and detection of PAVMS in family members.
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              Pulmonary arteriovenous fistulas.

              Previously reported from our institution has been a series of 63 patients with pulmonary arteriovenous fistula who were seen from Jan. 1, 1952, through Dec. 31, 1972. Subsequently, we have seen 38 additional patients during the 8 1/2-year period from Jan. 1, 1973, through June 1981. The series includes three patients with hereditary telangiectasia who had bilateral pulmonary arteriovenous fistulas removed at two separate thoracotomies. Our report also includes a brief description of five additional patients with acquired systemic artery-to-pulmonary artery fistula who underwent miniballoon occlusion of the fistula. We are including these five cases because we believe this therapeutic catheterization technique may be of particular value in patients with multiple or bilateral pulmonary arteriovenous malformations and may obviate extensive pulmonary resection and repeat thoracotomy. Pulmonary arteriovenous fistula is believed to occur most often in middle-aged women who have associated Rendu-Osler-Weber syndrome, but most of our patients did not have hereditary hemorrhagic telangiectasia. Twenty-three (36.5%) of the 63 patients in a previous Mayo Clinic series and 18 (47%) of the 38 in the present series had associated Rendu-Osler-Weber syndrome. A logical workup of a patient with pulmonary arteriovenous fistula includes, in sequential fashion based on priority, chest roentgenography and tomography, arterial blood gas measurements, contrast echocardiography with indocyanine green dye, angiography, and measurement of differential pulmonary venous oxygen content.
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                Author and article information

                Contributors
                nmggzl@163.com
                Journal
                Thorac Cancer
                Thorac Cancer
                10.1111/(ISSN)1759-7714
                TCA
                Thoracic Cancer
                John Wiley & Sons Australia, Ltd (Melbourne )
                1759-7706
                1759-7714
                23 June 2018
                August 2018
                : 9
                : 8 ( doiID: 10.1111/tca.2018.9.issue-8 )
                : 1082-1086
                Affiliations
                [ 1 ] Department of Thoracic Surgery Affiliated Hospital of Inner Mongolia Medical College Hohhot Inner Mongolia China
                [ 2 ] Department of Thoracic Surgery 253 Hospital The People's Liberation Army Hohhot Inner Mongolia China
                [ 3 ] Department of Anesthesiology Affiliated Hospital of Inner Mongolia Medical College Hohhot Inner Mongolia China
                Author notes
                [*] [* ] Correspondence

                Zhanlin Guo, Department of Thoracic Surgery, Affiliated Hospital of Inner Mongolia Medical College, 1 North Valley St, Hohhot, Inner Mongolia 010010, China.

                Tel: +86 471 345 1489

                Fax: +86 471 345 1489

                Email: nmggzl@ 123456163.com

                [†]

                These authors contributed equally to the paper.

                Author information
                http://orcid.org/0000-0002-7703-5629
                Article
                TCA12781
                10.1111/1759-7714.12781
                6068433
                29934984
                d3be171e-c3b3-4122-8c46-52479842b1d4
                © 2018 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 07 May 2018
                : 12 May 2018
                : 12 May 2018
                Page count
                Figures: 2, Tables: 0, Pages: 5, Words: 2178
                Categories
                Case Report
                Case Reports
                Custom metadata
                2.0
                tca12781
                August 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.4.4 mode:remove_FC converted:01.08.2018

                arteriovenous fistula,pulmonary,thoracoscopy
                arteriovenous fistula, pulmonary, thoracoscopy

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