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Segmental arterial ligation under video-assisted thoracoscopy combined with transcatheter embolotherapy for multiple bilateral pulmonary arteriovenous malformations

Department of Surgery, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-0021, Japan

^* Corresponding author. Address: Department of Surgery, School of Medicine, Keio University, Tokyo Metropolitan Komagome Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Tel.: +81-3-5363-3806; fax: +81-3-5363-3499. (E-mail: kohno{at}1993.jukuin.keio.ac.jp).

Multiple bilateral pulmonary arterio-venous malformations (PAVM) were diagnosed in a 15-year-old girl with erythrocytosis. Although transcatheter embolotherapy is generally accepted as a treatment of PAVM, the largest lesion in the right lower lobe was fed by a 13-mm diameter feeding artery without downstream narrowing, which was unsafe for the embolization of coils or balloons. Instead, we surgically ligated the largest feeding artery under video-assisted thoracoscopy, without losing any lung parenchyma. The other PAVM were successfully treated by embolization of metallic coils. The arterial partial pressure of oxygen (O₂) increased from 37 to 64mmHg on room air, and from 46 to 410mmHg on 100% O₂.