Occult Pulmonary Arteriovenous Malformation Resulting in Acute Mesenteric Ischemia and Post-Operative Respiratory Failure

• Published in: The American surgeon Vol. 77; no. 8; pp. 1096 - 1098
• Main Authors: MARKS, Joshua A, MARTIN, Niels D, JENOFF, Jay S, WEINSTEIN, Michael S
• Format: Journal Article
• Language: English
• Published: Atlanta, GA Southeastern Surgical Congress 01.08.2011; SAGE PUBLICATIONS, INC
• Subjects: Abdomen, Acute - diagnosis; Abdomen, Acute - etiology; Acute Disease; Angiography, Digital Subtraction - methods; Arteriovenous Malformations - complications; Arteriovenous Malformations - diagnostic imaging; Arteriovenous Malformations - surgery; Biological and medical sciences; Blood clots; Body Mass Index; Cardiology. Vascular system; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Emergency Treatment; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Heart; Humans; Ischemia; Ischemia - diagnostic imaging; Ischemia - surgery; Male; Medical imaging; Medical sciences; Mesenteric Ischemia; Middle Aged; Mortality; Obesity, Morbid - diagnosis; Other diseases. Semiology; Postoperative Complications - diagnostic imaging; Postoperative Complications - surgery; Postoperative period; Pulmonary arteries; Pulmonary Artery - abnormalities; Respiratory distress syndrome; Respiratory Insufficiency - diagnostic imaging; Respiratory Insufficiency - etiology; Respiratory Insufficiency - therapy; Risk Assessment; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Thrombectomy - adverse effects; Thrombectomy - methods; Tomography, X-Ray Computed - methods; Treatment Outcome; Vascular Diseases - diagnostic imaging; Vascular Diseases - surgery; Veins & arteries; Postoperative; Respiratory disease; Acute; Cardiovascular disease; Congenital pulmonary arteriovenous aneurysm; Congenital disease; Vascular disease; Medicine; Treatment; Respiratory failure; Malformation; Surgery; Mesenteric infarction
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313481107700837

Indications for treating PAVM include progressive PAVM enlargement, paradoxical embolization, and symptomatic hypoxemia.3 According to early reports, untreated lesions carry 26 per cent morbidity and 1 1 per cent mortality, and therefore, given die risks of bleeding and paradoxical embolization, even in me asymptomatic patient, treatment is advised.2,3 Surgical ligation, local excision, or lobectomy are all potential treatment options; however, endo vascular embolotherapy has become the mainstay of therapy as it carries a lower procedural morbidity then traditional thoracotomy, shorter time in the hospital, and more rapid return to work.2-4 Short and long term results of occlusion of the AVM, reduction of the right-to-left anatomic shunt fraction, and improvement in arterial oxygenation are excellent.3,4 Although reports exist of paradoxical embolization of septic material to the brain, kidney, and knee through a previously undiagnosed PAVM, acute SMA thrombosis has not been reported secondary to PAVM. In the early experience of embolotherapy, there are reports of the embolization device traveling to and lodging within the posterior division of the left internal iliac artery in one case, left popliteal artery in another, and in a peripheral branch of the hepatic artery in yet another case, illustrating the plausibility of lodging in the SMA in our patient.3 Our review of the literature found no other reports of an occult PAVM causing either paradoxical embolization specifically to the SMA resulting in life-threatening mesenteric ischemia or acute postoperative respiratory failure.