Surgery versus percutaneous transcatheter embolization for pulmonary arteriovenous malformation: Analysis of a national inpatient database in Japan

Objective: Although the treatment options for pulmonary arteriovenous malformation are surgery and percutaneous transcatheter embolization, no study has compared the outcomes between these 2 treatments. Methods: From the Japanese Diagnosis Procedure Combination database, the medical records of 996 patients who received treatment for pulmonary arteriovenous malformation between 2010 and 2015 were retrospectively reviewed. We created balanced groups for surgery or percutaneous transcatheter embolization using propensity scoring. The primary outcome was the rate of reintervention for pulmonary arteriovenous malformation, and the secondary outcomes were composite complications and postoperative length of stay. Patients who had any 1 of the complications during hospitalization were considered to have experienced a composite complication. Results: Of the total sample, 211 patients underwent surgery and 785 patients underwent percutaneous transcatheter embolization. By using 1-to-1 propensity score matching, 202 pairs were selected. Compared with percutaneous transcatheter embolization, surgery was associated with a significantly higher proportion of composite complications (6.9% vs 2.0%, P = .027) and longer postoperative length of hospital stay (median, 6 vs 2 days, P < .01). However, surgery resulted in a significantly lower rate of reintervention for pulmonary arteriovenous malformation (2.1% vs 8.3% at 2 years; P < .01). Conclusions: Percutaneous transcatheter embolization had the advantage in composite complications and shorter postoperative length of stay compared with surgery, but surgery had higher curability than percutaneous transcatheter embolization. Surgery may be considered as a therapeutic option for patients with lesions that can be completely resected and are difficult to treat with percutaneous transcatheter embolization.