Table 2. Indications and contraindications for endovascular treatment of PAVM.

Indications for endovascular therapy

PAVM with a feeding artery diameter (FAD) ≥2 mm, and technically feasible

Symptomatic PAVM regardless of size

Atypical but likely PAVM on cross sectional imaging and suggestive symptoms

Relative contraindications (possible alternative)

Asymptomatic PAVM with feeding artery diameter <2 mm (consider clinical and CT follow up)

PAVM that is not accessible/feasible for endovascular therapy (consider surgical resection)

Diffuse type PAVM (surgery/transplant)

Severe pulmonary hypertension (consider performing the procedure under local anesthesia only; decrease the rate and volume of injected contrast material; use hand injection; occlude only a few PAVMs during each treatment session)

Severe coagulopathy (correct underlying coagulopathy)

Renal failure (consider nephrology consult)

Allergy to iodinated contrast material (consider premedication)

Early pregnancy (PAVM can be treated in the second and third trimesters as pregnancy typically exacerbates and complicates PAVM presentation)

Asymptomatic PAVM in children

Left bundle branch block (consider temporary pacing)

PAVM, pulmonary arteriovenous malformations.