Contact and appointment information
Administrative
Office
Dr. James Gossage, MD,
Director
Section of Pulmonary
1120 15th Street
BBR5513
Augusta, GA 30912-3130
Phone: (706) 721-6791
Fax: (706) 721-3069
Patient Calls
New Patient Referrals and Questions:
(706) 721-6791
Return Patient Appointments:
Phone:
(706) 721-4495
Medication Refills:
Phone: (706) 721-1790
Map and directions
to Medical College of Georgia
Hospital & near-by hotels
Lung (Pulmonary) AVM
Pulmonary AVM (PAVM) are seen in about 30% of patients, and are especially common if someone else in your family has them. PAVM are potentially one of the most serious complications of HHT because they can result in strokes or brain abscesses. The problem with PAVM is that the fine network of capillaries that usually filters stuff from the blood is missing in the PAVM . Instead, a large artery connects directly to the vein and bypasses the lung tissue. This allows bacteria and small clots to pass directly to the brain. The good news is that these complications can be prevented in almost all cases.
Brain Abscess
Pulmonary AVM
General
information and prevention
• Take
antibiotics before any invasive procedures like
colonoscopy or dental
cleaning. Your PCP can usually
recommend an antibiotic for you based on
the
AHA Endocarditis Prophylaxis Guidelines.
• IV lines should always have an air filter in the line and be inserted while that part of your body is below the heart.
• Report any of the following symptoms to your doctor as soon as possible: coughing up blood, sudden weakness in your arms or legs, difficulty talking, blacking out spells, severe headaches, high fever, worsening shortness of breath.
• Avoid blood thinners or nonsteroidal antiinflammatory medicines like aspirin and ibuprofen as they can worsen bleeding tendencies. Tylenol®, Bextra®, Celebrex®, and Vioxx® are generally okay.
• Return to your HHT center at least every 5 years so that you can be monitored for development of new PAVM.
Treatment
• Embolization:
This involves blocking off the artery that leads into or “feeds” the PAVM
with a tiny metal coil or a small balloon. In either case, this stops the
blood flow to the PAVM. This is accomplished by passing a small catheter
through a vein in the leg and then passing in up to the arteries of the
lungs. This can usually be done at the same time as your pulmonary angiogram.
Depending on how long the test takes and on how many PAVM need to be embolized, you may go home the same day or may stay overnight. If you have a lot of PAVM, you may need to come back for additional embolization sessions. The procedure is successful in initially blocking off the PAVM more than 95% of the time and has a low complication rate. Depending on the size of the original PAVM, 5-15% of PAVM may reopen over time, and new PAVM may grow. Therefore, it is very important to follow up within 6 months and then at least every 3-5 years to check the success of the procedure.
• Surgical removal: This involves a formal surgical procedure to remove the part of the lung that contains the PAVM. This has a higher complication rate than embolization, but is generally well tolerated. Because of the success of embolization , surgery is only necessary in unusually large or complicated PAVM. As with embolization, it is very important to follow up at least every 3-5 years to check for growth of new PAVM.
Copyright
Medical College of Georgia
All rights reserved.
Department
of Medicine |
Medical College of
Georgia
September 12,2008
Please email questions and comments to:
James Gossage, MD