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

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 (O ₂) increased from 37 to 64 mmHg on room air, and from 46 to 410 mmHg on 100% O ₂.