What does this research mean for the field?

Perioperative veno-venous ECMO can successfully facilitate the surgical resection of pulmonary arteriovenous malformations in adults with severe, refractory hypoxic respiratory failure. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To explore the use of veno-venous ECMO in the surgical treatment of pulmonary arteriovenous malformations causing hypoxic respiratory failure in an adult patient.

May 20, 2026

C63-04 ECMO-Facilitated Surgical Repair of Pulmonary AVM in Adult With Hypoxic Respiratory Failure

Puntos clave

To explore the use of veno-venous ECMO in the surgical treatment of pulmonary arteriovenous malformations causing hypoxic respiratory failure in an adult patient.
Case report of a 71-year-old man with hypoxic respiratory failure and pulmonary AVM.
Patient management included veno-venous ECMO support during right-sided thoracoscopic surgery for PAVM resection.
Postoperative care involved monitoring for complications such as hemothorax and hemorrhagic shock.
Patient underwent successful surgery for pulmonary AVMs with the support of VV ECMO for oxygenation.
Postoperatively, resulted in complications requiring blood products and reintubation but ultimately led to recovery.
Patient weaned off oxygen and discharged to a rehabilitation facility after recovery.

Resumen

Abstract Introduction Spontaneous pulmonary arteriovenous malformation (PAVM), particularly in patients without hereditary hemorrhagic telangiectasia (HHT), is a rare etiology of severe hypoxic respiratory failure.1 Treatment includes embolization, surgical excision, or lung transplantation; however, management is often complicated by difficulty maintaining oxygenation due to right-to-left intrapulmonary shunting. Description A 71-year-old man with a distant history of mitral valve stenosis, atrial fibrillation on warfarin, heart failure with preserved ejection fraction, cryptogenic cirrhosis, and chronic thrombocytopenia was admitted with hypoxic respiratory failure. Chest CT showed numerous new PAVMs absent on imaging three years earlier. He has no personal or familial history of HHT and genetic testing during admission for common HHT markers was unrevealing. He had no evidence of pulmonary hypertension or hepatopulmonary syndrome. Due to the size and amount of PAVMs, embolization was deferred as the risks outweighed potential benefits. During admission, his oxygen requirements continued to escalate, necessitating the use of inhaled nitric oxide (iNO) as a bridge to surgical intervention. He was placed on veno-venous (VV) ECMO to maintain oxygenation during right-sided video-assisted thoracoscopic surgery with resection of PAVMs in the right middle and lower lung lobes. He was extubated and decannulated immediately post-operatively. Recovery was complicated by development of a large hemothorax and subsequent hemorrhagic shock requiring multiple blood products, vasopressors, intubation, and reinitiation of iNO. He was recannulated for ECMO and returned to the operating room for right-sided thoracotomy and hematoma evacuation. A few days after surgery, he was again decannulated and extubated. He was then weaned to low dose oxygen by nasal canula and discharged to an inpatient rehabilitation facility. Discussion Perioperative VV ECMO can facilitate surgical treatment of PAVMs causing severe hypoxic respiratory failure refractory to supplemental oxygenation. Although ECMO-use has been reported in infants with congenital PAVMs,2,3 our experience describes, to our knowledge, the first recorded use of ECMO for resection of PAVMs causing hypoxic respiratory failure in an adult. References: 1. Nakayama M, Nawa T, Chonan T, et al. Prevalence of pulmonary arteriovenous malformations as estimated by low-dose thoracic CT screening. Intern Med Tokyo Jpn. 2012;51(13):1677-1681. doi:10.2169/internalmedicine.51.7305. 2. Aggarwal V, Khan DM, Rhodes JF. Pulmonary Arteriovenous Malformation Causing Systemic Hypoxemia in Early Infancy. Case Rep Pediatr. 2017;2017(1):2841720. doi:10.1155/2017/2841720. 3. Guvenc O, Odemis E, Saygi M, Onalan MA. Transcatheter management of life-threatening pulmonary arteriovenous fistula with extracorporeal membrane oxygenation support in an infant. Cardiol Young. 2023;33(3):498-501. doi:10.1017/S1047951122002724. This abstract is funded by: None

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