Embolisation for pulmonary arteriovenous malformation

Hsu, Charlie C-T, Kwan, Gigi N. C., Thompson, Shane A., Evans-Barns, Hannah and van Driel, Mieke L. (2012) Embolisation for pulmonary arteriovenous malformation. Cochrane Database of Systematic Reviews, 8: . doi:10.1002/14651858.CD008017.pub3

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Author Hsu, Charlie C-T
Kwan, Gigi N. C.
Thompson, Shane A.
Evans-Barns, Hannah
van Driel, Mieke L.
Title Embolisation for pulmonary arteriovenous malformation
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2012-01-01
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD008017.pub3
Open Access Status DOI
Issue 8
Total pages 18
Place of publication Oxford, United Kingdom
Publisher John Wiley & Sons
Language eng
Formatted abstract
Background:  Pulmonary arteriovenous malformations are abnormal direct connections between the pulmonary artery and pulmonary vein which result in a right-to-left shunt. They are associated with substantial morbidity and mortality mainly from the effects of paradoxical emboli. Potential complications include stroke, cerebral abscess, pulmonary haemorrhage and hypoxaemia. Embolisation is an endovascular intervention based on the occlusion of the feeding arteries the pulmonary arteriovenous malformations thus eliminating the abnormal right-to-left-shunting.

Objectives: To determine the efficacy and safety of embolisation in patients with pulmonary arteriovenous malformations including a comparison with surgical resection and different embolisation devices.

Search methods: We searched the Cystic Fibrosis and Genetic Disorders Group's Trials Register; date of last search: 09 February 2012.

We also searched the following databases: the Australian New Zealand Clinical Trials Registry; ClinicalTrials.gov; International Standard Randomised Controlled Trial Number Register; International Clinical Trials Registry Platform Search Portal (last searched 15 May 2012).

We checked cross-references and searched references from review articles.

Selection criteria: Trials in which individuals with pulmonary arteriovenous malformations were randomly allocated to embolisation compared to no treatment, surgical resection or embolisation using a different embolisation device.

Data collection and analysis: Studies identified for potential inclusion were independently assessed for eligibility by two authors, with excluded studies further checked by a third author. No trials were identified for inclusion in the review and hence no analysis was performed.

Main results: There were no randomised controlled trials identified.

Authors' conclusions: There is no evidence from randomised controlled trials for embolisation of pulmonary arteriovenous malformations. However, randomised controlled trials are not always feasible on ethical grounds. Accumulated data from observational studies suggest that embolisation reduces morbidity. A standardised approach to reporting with long-term follow-up through registry studies can help to strengthen the evidence for embolisation in the absence of randomised controlled trials. 
Keyword Arteriovenous Malformations [therapy]
Embolization, Therapeutic [adverse effects; methods]
Pulmonary Artery [abnormalities]
Pulmonary Veins [abnormalities]
Hereditary Hemorrhagic Telangiectasia
Vascular Plug
Helical Ct
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ
Additional Notes This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2012, Issue 8. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Medicine Publications
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