Pulmonary arteriovenous malformations: which factors are associated with symptomatic neurologic complications in solitary lesions?

Purpose: The purpose of this study was to investigate the factors associated with symptomatic neurologic complications in solitary pulmonary arteriovenous malformations (PAVMs).

Materials and Methods: Patient data were obtained from 14 institutions. Data from 207 patients (28 men, 179 women; median age, 65 years; age range, 9–94 years) who were diagnosed with a solitary PAVM by CT between 2004 and 2020 were analyzed. Of these, 104 patients underwent treatment and 103 patients were observed. The median follow-up period was 22.5 months (range, 0–180 months). Thirty-six of the 207 patients had symptomatic neurologic complications (neurologic group; ischemic stroke, n = 34; brain abscess, n = 2). The remaining 171 patients had no neurologic symptoms (control group). Medical records and CT images were reviewed, and the relationships of the following factors to symptomatic neurologic complications were compared between the groups: sex, age, location of PAVM (left lung vs. right lung, upper or middle lobe vs. lower lobe, distal site vs. proximal site), type of PAVM (simple vs. complex), size of feeding artery, size of sac, sac-to-feeding artery ratio, and shape of PAVM (single saccular vs. multi-saccular).

Results: There was no difference between the two groups in terms of sex, age, location of PAVM, or type of PAVM. Median size of the feeding artery was 3.9 mm (range, 2.0–23.0 mm) and 3.0 mm (range, 0.9–9.3 mm) in the neurologic and control groups, respectively (p = 0.005). Median sac size was 9.9 mm (range, 3.5–25.7 mm) and 6.5 mm (range, 1.7–39.3 mm) in the neurologic and control groups, respectively (p < 0.0001). Median sac-to-feeding artery ratio was 2.5 (range, 0.2–4.4) and 2.0 (range, 1.0–5.9) in the neurologic and control groups, respectively (p = 0.015). There was a significant association of multi-saccular shape with symptomatic neurologic complications (p = 0.0023).

Conclusion: In patients with a solitary PAVM, the factors associated with symptomatic neurologic complications were size of feeding artery, size of sac, sac-to-feeding artery ratio, and multi-saccular shape of PAVM.