Uni-port video-assisted thoracoscopic surgery with vascular pre-blocking successfully manages large pulmonary arteriovenous malformationsSurgery with Pre-blocking Successfully Treats Large Lung Malformation

IntroductionPulmonary arteriovenous malformations (PAVMs) are uncommon vascular anomalies characterized by abnormal communications between pulmonary arteries and veins. Although transcatheter embolization is considered the first-line treatment for most PAVMs, surgical intervention remains an important option for selected patients, particularly those with large lesions or unfavorable anatomy. However, reports describing uniportal video-assisted thoracoscopic surgery (UVATS) for PAVM treatment remain limited. We report a case of a large PAVM successfully managed using UVATS with temporary pre-blocking of the feeding pulmonary artery and draining pulmonary vein, and review the literature regarding thoracoscopic management of PAVMs.Case descriptionA 43-year-old woman was admitted after a routine health examination revealed a right lower lobe pulmonary lesion. The patient was asymptomatic, and imaging studies, including contrast-enhanced computed tomography and three-dimensional reconstruction, demonstrated a 3.1 cm × 2.7 cm pulmonary arteriovenous malformation located in the outer basal segment of the right lower lobe (RS9). UVATS was performed through a single 3-cm incision. After complete hilar dissection, the right lower pulmonary artery and right lower pulmonary vein were temporarily occluded before wedge resection of the lesion. The operation was completed in 50 min without intraoperative complications. Postoperatively, room-air oxygen saturation improved from 92% to 98%, and arterial oxygen tension increased from 66 to 82 mmHg. Histopathological examination confirmed the diagnosis of PAVM. The chest tube was removed on postoperative day 2, and the patient was discharged on postoperative day 3. No recurrence or adverse events were observed during the 3-month follow-up period.ConclusionThis case demonstrates that UVATS combined with temporary pre-blocking of both the feeding and draining pulmonary vessels is a feasible and safe approach for selected patients with large PAVMs. Temporary vascular control may reduce the risks of intraoperative bleeding and embolic complications and facilitate successful minimally invasive resection. Further studies are warranted to evaluate the reproducibility and long-term outcomes of this strategy.