Purpose: To identify the adverse events following recurrence of pulmonary arteriovenous malformations (PAVMs) to evaluate potential risk to patients.
Material and Methods: The cohort included 31 patients with 80 previously treated recurrent PAVMs between April 2007 and November 2019. Of these 31 patients, 17 patients had previously untreated PAVMs along with recurrent PAVMs. The remaining 14 patients had recurrent PAVMs only. Clinical signs/symptoms following recurrence were identified by documentation from the electronic health record. PAVMs were classified by initial embolization technique as embolization within the PAVM nidus, distal feeding artery (within 1 cm of the nidus), or proximal feeding artery (greater than 1 cm from the nidus). The mechanism of recurrence was characterized as recanalization (flow through previously placed embolic material) or reperfusion (flow through accessory arteries).
Results: Mean patient age was 46.2 (+/- 14.3) years and 58.1% were female. Mean follow-up time from initial embolization was 6.3 (+/- 5.9) years. 20/31 (93.5%) patients had hereditary hemorrhagic telangiectasia (HHT), a disorder associated with PAVM formation. Distal feeding artery embolization was the initial embolization technique performed in 50/80 (62.5%) PAVMs. Recanalization was the most common pattern of recurrence, occurring in 54/80 (67.5%) PAVMs. The prevalence of neurologic complications following recurrence included 5/31 (16.1%) transient ischemic attacks (TIAs), 2/31 (6.5%) strokes, and 3/31 (9.7%) brain abscesses. Hemoptysis occurred in 2/31 (6.5%) patients following recurrence. Within the 14 patients with only recurrent PAVMs there was 1/14 (7.1%) TIA, 1/14 (7.1%) brain abscess and 1/14 (7.1%) occurrence of hemoptysis.
Conclusions: Recurrence of previously treated PAVMs can result in neurologic sequalae or hemoptysis, suggesting that treatment of recurrent PAVMs should remain the standard of care.