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Osler-Weber-Rendu Disease

  • Author: Klaus-Dieter Lessnau, MD, FCCP; Chief Editor: Vincent Lopez Rowe, MD  more...
 
Updated: Jun 29, 2015
 

Background

Osler-Weber-Rendu disease (OWRD) is a rare autosomal dominant disorder that affects blood vessels throughout the body (causing vascular dysplasia) and results in a tendency for bleeding. (The condition is also known as hereditary hemorrhagic telangiectasia [HHT]; the two terms are used interchangeably in this article.) The prognosis varies, depending on the severity of symptoms; generally, it is good, as long as bleeding is promptly recognized and adequately controlled.

HHT is manifested by mucocutaneous telangiectases and arteriovenous malformations (AVMs), a potential source of serious morbidity and mortality.[1] Lesions can affect the nasopharynx, central nervous system (CNS), lung, liver, and spleen, as well as the urinary tract, gastrointestinal (GI) tract, conjunctiva, trunk, arms, and fingers.[2, 3] Recurrent and severe epistaxis is the most common presentation, frequently leading to severe anemia that necessitates transfusion.[4] GI bleeding is also prevalent.[3, 5] Symptom onset may be delayed until the fourth decade of life (~90% of patients manifest by age 40 years) or later.[6, 7, 8]

The diagnosis of HHT is made clinically on the basis of the Curaçao criteria, established in June 1999 by the Scientific Advisory Board of the HHT Foundation International, Inc.[9] The four clinical diagnostic criteria are as follows:

  • Epistaxis
  • Telangiectasias
  • Visceral lesions
  • Family history (a first-degree relative with HHT)

The HHT diagnosis is classified as definite if three or four criteria are present, possible or suspected if two criteria are present, and unlikely if fewer than two criteria are present. (See DDx.)

The presentation of HHT can be highly variable among families and even within the same family.[10, 11, 9] Cutaneous findings may be subtle; epistaxis, the most common overt feature, is also common in the general population. There is no firm consensus on the number of episodes or degree of epistaxis necessary for diagnosis; according to the Curaçao criteria, nosebleeds should occur spontaneously on more than one occasion, and night-time bleeding should be considered especially suspicious.[9] (See Presentation.)

Genetic testing of OWRD patients and their family members can confirm the presence of mutations within implicated genes, most commonly the endoglin gene (ENG) in chromosome 9 or the activin receptorlike kinase type I (ALK-1) gene (ALK1) in chromosome 12 (involved in HHT type 1 and type 2, respectively).[4, 12, 13] Both ENG and ALK-1 encode putative receptors for the transforming growth factor-beta (TGF-β) superfamily that play a critical role for the proper development of the blood vessels.[14] Mutations in SMAD4 have also been identified in a subset of patients with a combined syndrome of HHT and juvenile poliposis.[14]

Screening family members for signs of OWRD is reasonable and should include a complete history, physical examination, chest radiography, and arterial blood gas testing (with measurement of the shunt fraction). (See Workup.)

Indications for intervention in OWRD vary according to site of involvement and presentation. In mild cases, no treatment is necessary. In more severe cases, treatment consists of management of bleeding via both medical and surgical options, as well as surgical management of AVMs and further sequelae. (See Treatment.)

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Pathophysiology

OWRD (ie, HHT) is the first identified human disease caused by defects in a TGF-β superfamily receptor.[14, 15] The clinical manifestations of OWRD are caused by the development of abnormal vasculature, including telangiectasias, AVMs, and aneurysms. Unaffected areas show normal vessel architecture on ultrastructural analysis.[16] Thus, researchers postulate that an initiating event combined with abnormal repair results in the lesions.[17]

Defects in the endothelial cell junctions, endothelial cell degeneration, and weakness of the perivascular connective tissue are thought to cause dilation of capillaries and postcapillary venules, which manifest as telangiectasias. Most commonly, telangiectasias involve the mucous membranes, as well as the skin, the conjunctiva, the retina, and the GI tract.

AVMs are abnormal tortuous vessels with both arterial and venous components. Larger AVMs can cause left-to-right shunting and, if sufficiently large, may contribute to high-output heart failure. Loss of the muscularis layer and disturbance of the elastic lamina of vessel walls may also give rise to aneurysms in multiple organ systems. AVMs are found in the lungs, brain, and liver.

Telangiectases and AVM bleeding tendency are attributed to localized vessel wall weakness, in part due to abnormal remodeling resulting from an imbalance in functions related to TGF-β.[11] Interactions with TGF-β signaling result in disorganized cytoskeletal structure and poor vascular tubule formation. The gene expression profiles of the vascular endothelial cells grown from HHT patients reveals dysregulation of genes involved with the following[18] :

  • Angiogenesis
  • Cytoskeletal integrity
  • Cell migration
  • Proliferation
  • Nitric oxide synthesis

HHT has been classified into the following four types, though more may exist:

  • HHT type 1
  • HHT type 2
  • HHT type 3
  • HHT−juvenile polyposis overlap syndrome (JPHT)

The genes most commonly implicated in HHT are the endoglin gene (ENG; HHT type 1) and the ALK-1 gene (ALK1; HHT type 2); other genes are less frequently involved (see Etiology).[19] Endoglin and ALK-1 are type III and type I TGF-β receptors, and both are exclusively expressed on vascular endothelial cells.

The binding of TGF-β to the type II TGF-β receptor on endothelial cells, which is accelerated in the presence of endoglin, results in the phosphorylation of the type I TGF-β receptors ALK-5 and ALK-1. Endoglin and ALK-1 bind directly to bone morphogenetic protein (BMP)-9 and BMP-10 and mediate their defects in conjunction with the type II BMP receptor (BMPR II).[20, 21] Phosphorylated ALK-5 and ALK-1 activate the downstream proteins Smad2/3 and Smad1/5, respectively.[22]

The activated Smad proteins dissociate from the type I TGF-β receptor, bind to Smad4, and enter the nucleus to transmit TGF-β signals by regulating transcription from specific gene promoters involved in angiogenesis. Therefore, a balance between the two signaling pathways involving ALK-5 and ALK-1 is important in determining the properties of endothelial cells during angiogenesis.

Histopathologic studies reveal large, irregular, thinly walled blood vessels, but the pathogenesis has not been fully established. One theory states that systemic nevus vascular damage may not be equally expressed in all individuals with HHT. Individuals with blood group type O are affected more often, whereas males and females are affected equally. Coagulation abnormalities and increased fibrinolytic activity in the lesions may contribute to the tendency for bleeding.

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Etiology

OWRD (ie, HHT) is a disorder that is inherited in an autosomal dominant fashion,[23, 24] though 20% of patients are unaware of a positive family history, partly because the lesions may be minimal and because 10% of patients have no episodes of bleeding. The homozygous condition probably is fatal.

HHT is attributed to genetic mutations that involve signaling of TGF-β.[11] Defects in at least four genes are implicated in its development,[25]  as follows:

  • Mutations of ENG (encoding endoglin) - These characterize HHT type 1 and involve chromosome 9, 9q33-34 [26]
  • Mutations of ALK1 (encoding ALK-1), also called ACVRL1 (activin A receptor kinase type II-like 1) - These are implicated in HHT type 2 and involve chromosome 12, 12q13 [27]
  • Mutations of chromosome 5 (5q31.1-32) - These are distinct from hereditary benign telangiectasia (HBT), a gene defect in RASA1 (chromosome 5q14) [12]
  • Mutations of SMAD4/MADH4 (encoding Smad4) - These are described in JPHT, [28, 29] which is also autosomal dominant, involves chromosome 18, and combines clinical manifestations of HHT and juvenile polyposis

The first two (HHT types 1 and 2) account for approximately 85% of cases.

In addition, some families show no links to any of the known loci. One patient with HHT and pulmonary hypertension with no mutation in ENG, ACVRL1, or SMAD4 but was found to have a nonsense mutation in BMPR2.[30]

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Epidemiology

United States statistics

OWRD (ie, HHT) is rare in North America. The reported incidence is 1-2 cases per 100,000 population annually. The overall prevalence is estimated to be approximately 1-2 cases per 10,000 population. However, the prevalence may be underestimated because many cases may be asymptomatic.[31] In Vermont, the frequency has been estimated at 1 case per 16,500 population.[2] The disease has a clinical penetrance of 97%.

International statistics

The worldwide prevalence is 1 case per 5000-10,000 population In Europe and Japan, the frequency is estimated to be between 1 in 5000 to 8000 people.[4, 14, 32, 33] The prevalence of HHT in a Danish population increased from 13.8 cases per 100,000 population in 1974 to 15.6 cases per 100,000 population in 1995.[34]

The frequency may vary considerably between populations. The highest rates are seen in parts of the Dutch Antilles among the Afro-Caribbean population, with a prevalence of between 1 case per 200 persons and 1 per 1331 persons in the Curaçao and Bonaire regions.[35, 36] In the French department of Ain, the prevalence is 1 case per 2351 persons; in France overall, it is 1 per 8345.[6] Other examples include the Danish island of Funen (1 per 3500) and northern England (1 per 39,216).[37, 7]

Age-, sex-, and race-related demographics

HHT may occur in children, in whom a tendency to bleed may be the first symptom.[38] However, it is far more common during puberty or adulthood. The syndrome most often manifests by the second or third decade of life, though it may also be clinically silent. Pulmonary AVMs may be congenital and therefore may present within the first year of life. The risk of GI tract bleeding increases in patients older than 50 years.

HHT occurs with equal frequency and severity in males and females.[39] Although it most commonly occurs in whites, it has a wide geographic distribution and has been described in people of Asian, African, and Arabic descent.

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Prognosis

Overall, life expectancy appears to be shortened by OWRD (ie, HHT)[40] ; nevertheless, with appropriate screening and aggressive management, life expectancy for the majority of patients may approach that of the normal population. Mortality shows an early peak at age 50 years and a later peak at 60-79 years related to acute complications.[32]

The prognosis is highly dependent on the severity of the disease—in particular, on the degree of systemic involvement, especially pulmonary, hepatic, and CNS involvement. Only 10% of patients die of complications of HHT.

The prevalence of brain AVM in HHT1 patients is 1000-fold higher than the prevalence in the general population (10 in 100,000), and in HHT2 patients it is 100-fold higher.[15] Pulmonary and CNS arteriovenous aneurysms may appear later in life. Patients with pulmonary AVMs and telangiectasis of the GI tract are at risk for life-threatening hemorrhage of the lungs and GI tract. Other sites of bleeding may include sites in the kidney, spleen, bladder, liver, meninges, and brain.

Strokes may be either hemorrhagic or ischemic. Of patients who have pulmonary AVMs, 2% per year are estimated to have a stroke, and 1% per year are estimated to develop a brain abscess. Retinal arteriovenous aneurysms occur only rarely. Patients are also at risk for high-output cardiac failure, migraines and further sequelae.

Frequent nosebleeds and melena may result from telangiectasia in the nose and GI tract. Patients with the severe form of HHT have heavy bleeding and resultant iron-deficiency anemia. Recurrent epistaxis is observed in as many as 90% of patients. In half the patients, the epistaxis becomes more serious with age, and blood transfusions are required in 10-30% of patients.

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Contributor Information and Disclosures
Author

Klaus-Dieter Lessnau, MD, FCCP Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Raghukumar D Thirumala, MD, MPH Fellow in Pulmonary Medicine, Lenox Hill Hospital, North Shore-Long Island Jewish Health System

Raghukumar D Thirumala, MD, MPH is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, Society of Critical Care Medicine, Society of Hospital Medicine

Disclosure: Nothing to disclose.

Dora E Izaguirre, MD Primary Care Physician; Researcher, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Dora E Izaguirre, MD is a member of the following medical societies: American Heart Association, American Medical Association, American Public Health Association, Colegio Medico de Honduras

Disclosure: Nothing to disclose.

Jesus Lanza, MD Fellow in Pulmonary and Critical Care Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Disclosure: Nothing to disclose.

Chief Editor

Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Society for Vascular Surgery, Vascular and Endovascular Surgery Society, Society for Clinical Vascular Surgery, Pacific Coast Surgical Association, Western Vascular Society

Disclosure: Nothing to disclose.

Acknowledgements

Geromanta Baleviciene, MD, Head and Professor, Department of Dermatology, Vilnius University, Medical Faculty, Lithuania

Disclosure: Nothing to disclose.

David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Richard J Cervin, MD, Consulting Staff, Department of Dermatology, Baltic-American Medical and Surgical Clinic, Lithuania

Disclosure: Nothing to disclose.

Max J Coppes, MD, PhD, MBA President, BC Cancer Agency, Vancouver

Max J Coppes, MD, PhD, MBA, is a member of the following medical societies: Alberta Medical Association, American College of Healthcare Executives, American Society of Pediatric Hematology/Oncology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mark A Crowe, MD Assistant Clinical Instructor, Department of Medicine, Division of Dermatology, University of Washington School of Medicine

Mark A Crowe, MD is a member of the following medical societies: American Academy of Dermatology and North American Clinical Dermatologic Society

Disclosure: Nothing to disclose.

Dirk M Elston, MD Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

James L Harper, MD Associate Professor, Department of Pediatrics, Division of Hematology/Oncology and Bone Marrow Transplantation, Associate Chairman for Education, Department of Pediatrics, University of Nebraska Medical Center; Assistant Clinical Professor, Department of Pediatrics, Creighton University School of Medicine; Director, Continuing Medical Education, Children's Memorial Hospital; Pediatric Director, Nebraska Regional Hemophilia Treatment Center

James L Harper, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American Federation for Clinical Research, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Council on Medical Student Education in Pediatrics, and Hemophilia and Thrombosis Research Society

Disclosure: Nothing to disclose.

James F McKinsey, MD Associate Professor of Clinical Surgery, Columbia University College of Physicians and Surgeons; Site Chief, Department of Surgery, Division of Vascular Surgery, Columbia University Medical Center

James F McKinsey, MD is a member of the following medical societies: Alpha Omega Alpha and Association for Academic Surgery

Disclosure: Nothing to disclose.

Christen M Mowad, MD Associate Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Arun Panigrahi, MD Fellow in Pediatric Hematology-Oncology, University of Chicago, The Pritzker School of Medicine

Arun Panigrahi, MD is a member of the following medical societies: American Academy of Pediatrics and American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

William H Pearce, MD Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University School of Medicine

William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, and Western Surgical Association

Disclosure: Nothing to disclose.

James Petros, MD Associate Professor of Surgery, Program Director, Surgical Residency Program, Department of Surgery, Boston University School of Medicine

James Petros, MD is a member of the following medical societies: American Medical Association, American Society of Colon and Rectal Surgeons, Massachusetts Medical Society, and Society of Surgical Oncology

Disclosure: Nothing to disclose.

Sharada A Sarnaik, MBBS Professor of Pediatrics, Wayne State University School of Medicine; Director, Sickle Cell Center, Attending Hematologist/Oncologist, Children's Hospital of Michigan

Sharada A Sarnaik, MBBS is a member of the following medical societies: American Association of Blood Banks, American Association of University Professors, American Society of Hematology, American Society of Pediatric Hematology/Oncology, New York Academy of Sciences, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Norman A Silver, MD Assistant Professor, Department of Emergency Medicine, University of Manitoba, Winnipeg, Canada

Norman A Silver is a member of the following medical societies: American Academy of Pediatrics and Canadian Medical Association

Disclosure: Nothing to disclose.

Perry A Soriano, MD, FACS Staff Surgical Oncologist, Division of General Surgery, The Everett Clinic

Perry A Soriano, MD, FACS is a member of the following medical societies: American College of Surgeons, Massachusetts Medical Society, Pancreas Club, and Society of Surgical Oncology

Disclosure: Nothing to disclose.

Kent Stobart, MD, MSc, FRCPC Department of Pediatrics, Associate Professor, Stollery Children's Hospital

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Lawrence C Wolfe, MD Associate Chief for Hematology and Safety, Division of Pediatric Hematology-Oncology, Cohen Children's Medical Center

Lawrence C Wolfe, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association of Blood Banks, American Society of Hematology, Children's Oncology Group, and Eastern Society for Pediatric Research

Disclosure: Nothing to disclose.

Acknowledgments

The authors acknowledge valuable personal communication with Dr Robert I White Jr, medical director of Yale AVM and HHT Center, deemed an HHT Center of Excellence by the HHT Foundation International.

References
  1. Giordano P, Lenato GM, Suppressa P, Lastella P, Dicuonzo F, Chiumarulo L, et al. Hereditary hemorrhagic telangiectasia: arteriovenous malformations in children. J Pediatr. 2013 Jul. 163(1):179-86.e1-3. [Medline].

  2. Guttmacher AE, Marchuk DA, White RI Jr. Hereditary hemorrhagic telangiectasia. N Engl J Med. 1995 Oct 5. 333(14):918-24. [Medline].

  3. Nanda S, Bhatt SP. Hereditary hemorrhagic telangiectasia: epistaxis and hemoptysis. CMAJ. 2009 Apr 14. 180(8):838. [Medline].

  4. Franchini M, Frattini F, Crestani S, Bonfanti C. Novel treatments for epistaxis in hereditary hemorrhagic telangiectasia: a systematic review of the clinical experience with thalidomide. J Thromb Thrombolysis. 2013 Oct. 36(3):355-7. [Medline].

  5. Haitjema TJ, van Snippenburg R, Disch FJ, Overtoom TT, Westermann CJ. [Recurrent epistaxis: sometimes Rendu-Osler-Weber disease]. Ned Tijdschr Geneeskd. 1996 Nov 2. 140(44):2157-60. [Medline].

  6. Plauchu H, de Chadarévian JP, Bideau A, Robert JM. Age-related clinical profile of hereditary hemorrhagic telangiectasia in an epidemiologically recruited population. Am J Med Genet. 1989 Mar. 32(3):291-7. [Medline].

  7. Porteous ME, Burn J, Proctor SJ. Hereditary haemorrhagic telangiectasia: a clinical analysis. J Med Genet. 1992 Aug. 29(8):527-30. [Medline]. [Full Text].

  8. Irani F, Kasmani R. Hereditary hemorrhagic telangiectasia: fatigue and dyspnea. CMAJ. 2009 Apr 14. 180(8):839. [Medline].

  9. Shovlin CL, Guttmacher AE, Buscarini E, et al. Diagnostic criteria for hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber syndrome). Am J Med Genet. 2000 Mar 6. 91(1):66-7. [Medline].

  10. Shovlin CL, Hughes JM. Hereditary hemorrhagic telangiectasia. N Engl J Med. 1996 Feb 1. 334(5):330-1; author reply 331-2. [Medline].

  11. Shovlin CL, Letarte M. Hereditary haemorrhagic telangiectasia and pulmonary arteriovenous malformations: issues in clinical management and review of pathogenic mechanisms. Thorax. 1999 Aug. 54(8):714-29. [Medline]. [Full Text].

  12. Cole SG, Begbie ME, Wallace GM, Shovlin CL. A new locus for hereditary haemorrhagic telangiectasia (HHT3) maps to chromosome 5. J Med Genet. 2005 Jul. 42(7):577-82. [Medline]. [Full Text].

  13. Prigoda N L, Savas S, Abdalla S A, et al. Hereditary haemorrhagic telangiectasia: mutation detection, test sensitivity and novel mutations. J Med Genet. 2006 september. 43:722-8. [Medline].

  14. Zucco L, Zhang Q, Kuliszewski MA, Kandic I, Faughnan ME, Stewart DJ, et al. Circulating angiogenic cell dysfunction in patients with hereditary hemorrhagic telangiectasia. PLoS One. 2014. 9(2):e89927. [Medline]. [Full Text].

  15. Choi EJ, Chen W, Jun K, Arthur HM, Young WL, Su H. Novel brain arteriovenous malformation mouse models for type 1 hereditary hemorrhagic telangiectasia. PLoS One. 2014. 9(2):e88511. [Medline]. [Full Text].

  16. Braverman IM, Keh A, Jacobson BS. Ultrastructure and three-dimensional organization of the telangiectases of hereditary hemorrhagic telangiectasia. J Invest Dermatol. 1990 Oct. 95(4):422-7. [Medline].

  17. van Laake LW, van den Driesche S, Post S, et al. Endoglin has a crucial role in blood cell-mediated vascular repair. Circulation. 2006 Nov 21. 114(21):2288-97. [Medline].

  18. Fernandez-L A, Garrido-Martin EM, Sanz-Rodriguez F, et al. Gene expression fingerprinting for human hereditary hemorrhagic telangiectasia. Hum Mol Genet. 2007 Jul 1. 16(13):1515-33. [Medline].

  19. McDonald J, Bayrak-Toydemir P, Pyeritz RE. Hereditary hemorrhagic telangiectasia: an overview of diagnosis, management, and pathogenesis. genetics in medicine. 2011. 13(7):607-616. [Medline].

  20. David L, Mallet C, Mazebourg S, Feige J, Bailly S. Identification of BMP9 and BMP10 as functional activators of the orphan activin receptor-like kinase 1 (ALK1) in endothelial cells. Blood. 2007. 109 (5):1953-61. [Medline].

  21. Jerkic M, Sotov V, Letarte M. Oxidative stress contributes to endothelial dysfunction in mouse models of hereditary hemorrhagic telangiectasia. Oxid Med Cell Longev. 2012. 2012:686972. [Medline]. [Full Text].

  22. Shovlin CL, Hughes JM, Scott J, Seidman CE, Seidman JG. Characterization of endoglin and identification of novel mutations in hereditary hemorrhagic telangiectasia. Am J Hum Genet. 1997 Jul. 61(1):68-79. [Medline]. [Full Text].

  23. Grover S, Grewal RS, Verma R, Sahni H, Muralidhar R, Sinha P. Osler-Weber-Rendu syndrome: a case report with familial clustering. Indian J Dermatol Venereol Leprol. 2009 Jan-Feb. 75(1):100-1. [Medline].

  24. Richards-Yutz J, Grant K, Chao EC, Walther SE, Ganguly A. Update on molecular diagnosis of hereditary hemorrhagic telangiectasia. Hum Genet. 2010 Jul. 128(1):61-77. [Medline].

  25. Gedge F, McDonald J, Phansalkar A, et al. Clinical and analytical sensitivities in hereditary hemorrhagic telangiectasia testing and a report of de novo mutations. J Mol Diagn. 2007 Apr. 9(2):258-65. [Medline]. [Full Text].

  26. McAllister KA, Grogg KM, Johnson DW, et al. Endoglin, a TGF-beta binding protein of endothelial cells, is the gene for hereditary haemorrhagic telangiectasia type 1. Nat Genet. 1994 Dec. 8(4):345-51. [Medline].

  27. Johnson DW, Berg JN, Baldwin MA, et al. Mutations in the activin receptor-like kinase 1 gene in hereditary haemorrhagic telangiectasia type 2. Nat Genet. 1996 Jun. 13(2):189-95. [Medline].

  28. Gallione CJ, Repetto GM, Legius E, et al. A combined syndrome of juvenile polyposis and hereditary haemorrhagic telangiectasia associated with mutations in MADH4 (SMAD4). Lancet. 2004 Mar 13. 363(9412):852-9. [Medline].

  29. Abdalla SA, Letarte M. Hereditary haemorrhagic telangiectasia: current views on genetics and mechanisms of disease. J Med Genet. 2006 Feb. 43(2):97-110. [Medline]. [Full Text].

  30. Rigelsky CM, Jennings C, Lehtonen R, Minai OA, Eng C, Aldred MA. BMPR2 mutation in a patient with pulmonary arterial hypertension and suspected hereditary hemorrhagic telangiectasia. Am J Med Genet A. 2008 Oct 1. 146A(19):2551-6. [Medline].

  31. Begbie ME, Wallace GM, Shovlin CL. Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome): a view from the 21st century. Postgrad Med J. 2003 Jan. 79(927):18-24. [Medline]. [Full Text].

  32. Kjeldsen AD, Oxhøj H, Andersen PE, et al. Pulmonary arteriovenous malformations: screening procedures and pulmonary angiography in patients with hereditary hemorrhagic telangiectasia. Chest. 1999 Aug. 116(2):432-9. [Medline].

  33. Dakeishi M, Shioya T, Wada Y, et al. Genetic epidemiology of hereditary hemorrhagic telangiectasia in a local community in the northern part of Japan. Hum Mutat. 2002 Feb. 19(2):140-8. [Medline].

  34. Kjeldsen AD, Vase P, Green A. Hereditary haemorrhagic telangiectasia: a population-based study of prevalence and mortality in Danish patients. J Intern Med. 1999 Jan. 245(1):31-9. [Medline].

  35. Jessurun GA, Kamphuis DJ, van der Zande FH, Nossent JC. Cerebral arteriovenous malformations in The Netherlands Antilles. High prevalence of hereditary hemorrhagic telangiectasia-related single and multiple cerebral arteriovenous malformations. Clin Neurol Neurosurg. 1993 Sep. 95(3):193-8. [Medline].

  36. Westermann CJ, Rosina AF, De Vries V, de Coteau PA. The prevalence and manifestations of hereditary hemorrhagic telangiectasia in the Afro-Caribbean population of the Netherlands Antilles: a family screening. Am J Med Genet A. 2003 Feb 1. 116A(4):324-8. [Medline].

  37. Vase P, Grove O. Gastrointestinal lesions in hereditary hemorrhagic telangiectasia. Gastroenterology. 1986 Nov. 91(5):1079-83. [Medline].

  38. Urushihara M, Furukawa S, Ota A, Iwai A, Matsumura K, Hamada Y. Hemorrhagic telangiectasia with thrombocytopenia in a newborn infant. Pediatr Int. 2000 Dec. 42(6):693-5. [Medline].

  39. Schoen FJ. Cotran RS, Vinay K, Collins T. Robbins Pathologic Basis of Disease. 5th. WB Saunders; 1994. 509.

  40. Sabbà C, Pasculli G, Suppressa P, D'Ovidio F, Lenato GM, Resta F, et al. Life expectancy in patients with hereditary haemorrhagic telangiectasia. QJM. 2006 May. 99(5):327-34. [Medline].

  41. Fulbright RK, Chaloupka JC, Putman CM, et al. MR of hereditary hemorrhagic telangiectasia: prevalence and spectrum of cerebrovascular malformations. AJNR Am J Neuroradiol. 1998 Mar. 19(3):477-84. [Medline].

  42. Rebeiz EE, Bryan DJ, Ehrlichman RJ, Shapshay SM. Surgical management of life-threatening epistaxis in Osler-Weber-Rendu disease. Ann Plast Surg. 1995 Aug. 35(2):208-13. [Medline].

  43. Hoag JB, Terry P, Mitchell S, Reh D, Merlo CA. An epistaxis severity score for hereditary hemorrhagic telangiectasia. Laryngoscope. 2010 Apr. 120(4):838-43. [Medline].

  44. Shovlin CL, Chamali B, Santhirapala V, et al. Ischaemic strokes in patients with pulmonary arteriovenous malformations and hereditary hemorrhagic telangiectasia: associations with iron deficiency and platelets. PLoS One. 2014. 9(2):e88812. [Medline]. [Full Text].

  45. van Gent MW, Post MC, Snijder RJ, Westermann CJ, Plokker HW, Mager JJ. Real prevalence of pulmonary right-to-left shunt according to genotype in patients with hereditary hemorrhagic telangiectasia: a transthoracic contrast echocardiography study. Chest. 2010 Oct. 138(4):833-9. [Medline].

  46. Lacombe P, Lagrange C, Beauchet A, El Hajjam M, Chinet T, Pelage JP. Diffuse pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia: long-term results of embolization according to the extent of lung involvement. Chest. 2009 Apr. 135(4):1031-7. [Medline].

  47. Jakobi P, Weiner Z, Best L, Itskovitz-Eldor J. Hereditary hemorrhagic telangiectasia with pulmonary arteriovenous malformations. Obstet Gynecol. 2001 May. 97(5 Pt 2):813-4. [Medline].

  48. Cottin V, Dupuis-Girod S, Lesca G, Cordier JF. Pulmonary vascular manifestations of hereditary hemorrhagic telangiectasia (rendu-osler disease). Respiration. 2007. 74(4):361-78. [Medline].

  49. Berg J, Porteous M, Reinhardt D, Gallione C, Holloway S, Umasunthar T, et al. Hereditary haemorrhagic telangiectasia: a questionnaire based study to delineate the different phenotypes caused by endoglin and ALK1 mutations. J Med Genet. 2003 Aug. 40(8):585-90. [Medline]. [Full Text].

  50. McDonald MJ, Brophy BP, Kneebone C. Rendu-Osler-Weber syndrome: a current perspective on cerebral manifestations. J Clin Neurosci. 1998 Jul. 5(3):345-50. [Medline].

  51. Poisson A, Vasdev A, Brunelle F, Plauchu H, Dupuis-Girod S. Acute paraplegia due to spinal arteriovenous fistula in two patients with hereditary hemorrhagic telangiectasia. Eur J Pediatr. 2009 Feb. 168(2):135-9. [Medline].

  52. Calhoun AR, Bollo RJ, Garber ST, McDonald J, Stevenson DA, Hung IH, et al. Spinal arteriovenous fistulas in children with hereditary hemorrhagic telangiectasia. J Neurosurg Pediatr. 2012 Jun. 9(6):654-9. [Medline].

  53. Goodenberger DM. Visceral manifestations of hereditary hemorrhagic telangiectasia. Trans Am Clin Climatol Assoc. 2004. 115:185-99. [Medline]. [Full Text].

  54. Römer W, Burk M, Schneider W. [Hereditary hemorrhagic telangiectasia (Osler's disease)]. Dtsch Med Wochenschr. 1992 Apr 24. 117(17):669-75. [Medline].

  55. AAssar OS, Friedman CM, White RI Jr. The natural history of epistaxis in hereditary hemorrhagic telangiectasia. Laryngoscope. 1991 Sep. 101(9):977-80. [Medline].

  56. White RI Jr, Lynch-Nyhan A, Terry P, et al. Pulmonary arteriovenous malformations: techniques and long-term outcome of embolotherapy. Radiology. 1988 Dec. 169(3):663-9. [Medline].

  57. Berg JN, Guttmacher AE, Marchuk DA, Porteous ME. Clinical heterogeneity in hereditary haemorrhagic telangiectasia: are pulmonary arteriovenous malformations more common in families linked to endoglin?. J Med Genet. 1996 Mar. 33(3):256-7. [Medline]. [Full Text].

  58. Cottin V, Chinet T, Lavolé A, et al. Pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia: a series of 126 patients. Medicine (Baltimore). 2007 Jan. 86(1):1-17. [Medline].

  59. Pierucci P, Murphy J, Henderson KJ, et al. New definition and natural history of patients with diffuse pulmonary arteriovenous malformations: twenty-seven-year experience. Chest. 2008 Mar. 133(3):653-61. [Medline].

  60. Trembath RC, Thomson JR, Machado RD, et al. Clinical and molecular genetic features of pulmonary hypertension in patients with hereditary hemorrhagic telangiectasia. N Engl J Med. 2001 Aug 2. 345(5):325-34. [Medline].

  61. Press OW, Ramsey PG. Central nervous system infections associated with hereditary hemorrhagic telangiectasia. Am J Med. 1984 Jul. 77(1):86-92. [Medline].

  62. García-Mónaco R, Taylor W, Rodesch G, et al. Pial arteriovenous fistula in children as presenting manifestation of Rendu-Osler-Weber disease. Neuroradiology. 1995 Jan. 37(1):60-4. [Medline].

  63. Krings T, Chng SM, Ozanne A, Alvarez H, Rodesch G, Lasjaunias PL. Hereditary hemorrhagic telangiectasia in children: endovascular treatment of neurovascular malformations: results in 31 patients. Neuroradiology. 2005 Dec. 47(12):946-54. [Medline].

  64. Easey AJ, Wallace GM, Hughes JM, et al. Should asymptomatic patients with hereditary haemorrhagic telangiectasia (HHT) be screened for cerebral vascular malformations? Data from 22,061 years of HHT patient life. J Neurol Neurosurg Psychiatry. 2003 Jun. 74(6):743-8. [Medline]. [Full Text].

  65. Maher CO, Piepgras DG, Brown RD Jr, et al. Cerebrovascular manifestations in 321 cases of hereditary hemorrhagic telangiectasia. Stroke. 2001 Apr. 32(4):877-82. [Medline].

  66. Cloft HJ. Spontaneous regression of cerebral arteriovenous malformation in hereditary hemorrhagic telangiectasia. AJNR Am J Neuroradiol. 2002 Jun-Jul. 23(6):1049-50. [Medline].

  67. Du R, Hashimoto T, Tihan T, et al. Growth and regression of arteriovenous malformations in a patient with hereditary hemorrhagic telangiectasia. Case report. J Neurosurg. 2007 Mar. 106(3):470-7. [Medline].

  68. Leung KM, Agid R, terBrugge K. Spontaneous regression of a cerebral arteriovenous malformation in a child with hereditary hemorrhagic telangiectasia. Case report. J Neurosurg. 2006 Nov. 105(5 Suppl):428-31. [Medline].

  69. Proctor DD, Henderson KJ, Dziura JD, Longacre AV, White RI Jr. Enteroscopic evaluation of the gastrointestinal tract in symptomatic patients with hereditary hemorrhagic telangiectasia. J Clin Gastroenterol. 2005 Feb. 39(2):115-9. [Medline].

  70. Abdalla SA, Geisthoff UW, Bonneau D, et al. Visceral manifestations in hereditary haemorrhagic telangiectasia type 2. J Med Genet. 2003 Jul. 40(7):494-502. [Medline]. [Full Text].

  71. van Cutsem E, Rutgeerts P, Vantrappen G. Treatment of bleeding gastrointestinal vascular malformations with oestrogen-progesterone. Lancet. 1990 Apr 21. 335(8695):953-5. [Medline].

  72. Wu JS, Saluja S, Garcia-Tsao G, et al. Liver involvement in hereditary hemorrhagic telangiectasia: CT and clinical findings do not correlate in symptomatic patients. AJR Am J Roentgenol. 2006 Oct. 187(4):W399-405. [Medline].

  73. Garcia-Tsao G. Liver involvement in hereditary hemorrhagic telangiectasia (HHT). J Hepatol. 2007 Mar. 46(3):499-507. [Medline].

  74. Garcia-Tsao G, Swanson KL. Hepatic vascular malformations in hereditary hemorrhagic telangiectasia: in search of predictors of significant disease. Hepatology. 2008 Nov. 48(5):1377-9. [Medline].

  75. Larson AM. Liver disease in hereditary hemorrhagic telangiectasia. J Clin Gastroenterol. 2003 Feb. 36(2):149-58. [Medline].

  76. Garcia-Tsao G, Korzenik JR, Young L, et al. Liver disease in patients with hereditary hemorrhagic telangiectasia. N Engl J Med. 2000 Sep 28. 343(13):931-6. [Medline].

  77. Alizad A, Seward JB. Echocardiographic features of genetic diseases: part 3. Shunts. J Am Soc Echocardiogr. 2000 Mar. 13(3):248-53. [Medline].

  78. Mohler ER, Doraiswamy V, Sibley A et al. Transillumination of the fingers for vascular anomalies: a novel method for evaluating hereditary hemorrhagic telangiectasia. Genetics in Medicine. May 2009. 11(5):356-8.

  79. Shovlin CL, Sodhi V, McCarthy A, Lasjaunias P, Jackson JE, Sheppard MN. Estimates of maternal risks of pregnancy for women with hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome): suggested approach for obstetric services. BJOG. 2008 Aug. 115(9):1108-15. [Medline].

  80. Gershon AS, Faughnan ME, Chon KS, et al. Transcatheter embolotherapy of maternal pulmonary arteriovenous malformations during pregnancy. Chest. 2001 Feb. 119(2):470-7. [Medline].

  81. Khalid SK, Pershbacher J, Makan M, Barzilai B, Goodenberger D. Worsening of nose bleeding heralds high cardiac output state in hereditary hemorrhagic telangiectasia. Am J Med. 2009 Aug. 122(8):779.e1-9. [Medline].

  82. Nanthakumar K, Graham AT, Robinson TI, et al. Contrast echocardiography for detection of pulmonary arteriovenous malformations. Am Heart J. 2001 Feb. 141(2):243-6. [Medline].

  83. Schneider G, Uder M, Koehler M, et al. MR angiography for detection of pulmonary arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia. AJR Am J Roentgenol. 2008 Apr. 190(4):892-901. [Medline].

  84. Shovlin CL, Sulaiman NL, Govani FS, Jackson JE, Begbie ME. Elevated factor VIII in hereditary haemorrhagic telangiectasia (HHT): association with venous thromboembolism. Thromb Haemost. 2007 Nov. 98(5):1031-9. [Medline].

  85. De Pascalis A, Napoli M, Aprile M, Antonaci A, D'Amelio A, Buongiorno E. Gross hematuria due to acquired haemophilia in hereditary hemorrhagic telangiectasia. Blood Coagul Fibrinolysis. 2008 Oct. 19(7):731-3. [Medline].

  86. Faughnan ME, Hyland RH, Nanthakumar K, Redelmeier DA. Screening in hereditary hemorrhagic telangiectasia patients. Chest. 2000 Aug. 118(2):566-7. [Medline].

  87. Thompson RD, Jackson J, Peters AM, et al. Sensitivity and specificity of radioisotope right-left shunt measurements and pulse oximetry for the early detection of pulmonary arteriovenous malformations. Chest. 1999 Jan. 115(1):109-13. [Medline].

  88. Manson D, Traubici J, Mei-Zahav M, MacLuskey I, John P, Stephens D. Pulmonary nodular opacities in children with hereditary hemorrhagic telangiectasia. Pediatr Radiol. 2007 Mar. 37(3):264-8. [Medline].

  89. Al-Saleh S, Dragulescu A, Manson D, Golding F, Traubici J, Mei-Zahav M, et al. Utility of contrast echocardiography for pulmonary arteriovenous malformation screening in pediatric hereditary hemorrhagic telangiectasia. J Pediatr. 2012 Jun. 160(6):1039-43.e1. [Medline].

  90. Milot L, Kamaoui I, Gautier G, Pilleul F. Hereditary-hemorrhagic telangiectasia: one-step magnetic resonance examination in evaluation of liver involvement. Gastroenterol Clin Biol. 2008 Aug-Sep. 32(8-9):677-85. [Medline].

  91. Suga K, Ishikawa Y, Matsunaga N, Tanaka N, Suda H, Handa T. Liver involvement in hereditary haemorrhagic telangiectasia: assessment with 99Tcm-phytate radionuclide angiography and 123I-IMP transrectal portal scintigraphy. Br J Radiol. 2000 Oct. 73(874):1115-9. [Medline].

  92. Zukotynski K, Chan RP, Chow CM, Cohen JH, Faughnan ME. Contrast echocardiography grading predicts pulmonary arteriovenous malformations on CT. Chest. 2007 Jul. 132(1):18-23. [Medline].

  93. Wooderchak W, Gedge F, McDonald M, et al. Hereditary hemorrhagic telangiectasia: two distinct ENG deletions in one family. Clin Genet. 2010 Nov. 78(5):484-9. [Medline].

  94. [Guideline] Adler DG, Leighton JA, Davila RE, Hirota WK, Jacobson BC, Qureshi WA, et al. ASGE guideline: The role of endoscopy in acute non-variceal upper-GI hemorrhage. Gastrointest Endosc. 2004 Oct. 60(4):497-504. [Medline].

  95. Hahne M, Riemann JF. Vascular Abnormalities. Atlas of Capsule Endoscopy. Given Imaging; 2002. Ch 7, 73-81.

  96. Ingrosso M, Sabbà C, Pisani A, et al. Evidence of small-bowel involvement in hereditary hemorrhagic telangiectasia: a capsule-endoscopic study. Endoscopy. 2004 Dec. 36(12):1074-9. [Medline].

  97. Grève E, Moussata D, Gaudin JL, et al. High diagnostic and clinical impact of small-bowel capsule endoscopy in patients with hereditary hemorrhagic telangiectasia with overt digestive bleeding and/or severe anemia. Gastrointest Endosc. 2010 Apr. 71(4):760-7. [Medline].

  98. Ramchandani M, Reddy DN, Gupta R, Lakhtakia S, Tandan M, Darisetty S, et al. Spiral enteroscopy: a preliminary experience in Asian population. J Gastroenterol Hepatol. 2010 Nov. 25(11):1754-7. [Medline].

  99. Jacobson BS. Hereditary hemorrhagic telangiectasia: A model for blood vessel growth and enlargement. Am J Pathol. 2000 Mar. 156(3):737-42. [Medline]. [Full Text].

  100. Robin ED, Laman D, Horn BR, Theodore J. Platypnea related to orthodeoxia caused by true vascular lung shunts. N Engl J Med. 1976 Apr 22. 294(17):941-3. [Medline].

  101. Harries PG, Brockbank MJ, Shakespeare PG, Carruth JA. Treatment of hereditary haemorrhagic telangiectasia by the pulsed dye laser. J Laryngol Otol. 1997 Nov. 111(11):1038-41. [Medline].

  102. Harrison DF. Use of estrogen in treatment of familial hemorrhagic telangiectasia. Laryngoscope. 1982 Mar. 92(3):314-20. [Medline].

  103. Dallas NA, Samuel S, Xia L, et al. Endoglin (CD105): a marker of tumor vasculature and potential target for therapy. Clin Cancer Res. 2008 Apr 1. 14(7):1931-7. [Medline].

  104. Shah RK, Dhingra JK, Shapshay SM. Hereditary hemorrhagic telangiectasia: a review of 76 cases. Laryngoscope. 2002 May. 112(5):767-73. [Medline].

  105. Yaniv E, Preis M, Hadar T, Shvero J, Haddad M. Antiestrogen therapy for hereditary hemorrhagic telangiectasia: a double-blind placebo-controlled clinical trial. Laryngoscope. 2009 Feb. 119(2):284-8. [Medline].

  106. Isaacs E. Aminocaproic Acid. Pediatric Drug Dosage Handbook. 8th ed. Ottawa, Canada: Winnipeg Health Sciences Center and CSHP; 1998. 161.

  107. Lebrin F, Srun S, Raymond K, et al. Thalidomide stimulates vessel maturation and reduces epistaxis in individuals with hereditary hemorrhagic telangiectasia. Nat Med. 2010 Apr. 16(4):420-8. [Medline].

  108. Harvey RJ, Kanagalingam J, Lund VJ. The impact of septodermoplasty and potassium-titanyl-phosphate (KTP) laser therapy in the treatment of hereditary hemorrhagic telangiectasia-related epistaxis. Am J Rhinol. 2008 Mar-Apr. 22(2):182-7. [Medline].

  109. Lesnik GT, Ross DA, Henderson KJ, Joe JK, Leder SB, White RI Jr. Septectomy and septal dermoplasty for the treatment of severe transfusion-dependent epistaxis in patients with hereditary hemorrhagic telangiectasia and septal perforation. Am J Rhinol. 2007 May-Jun. 21(3):312-5. [Medline].

  110. Layton KF, Kallmes DF, Gray LA, Cloft HJ. Endovascular treatment of epistaxis in patients with hereditary hemorrhagic telangiectasia. AJNR Am J Neuroradiol. 2007 May. 28(5):885-8. [Medline].

  111. de Gussem EM, Snijder RJ, Disch FJ, Zanen P, Westermann CJ, Mager JJ. The effect of N-acetylcysteine on epistaxis and quality of life in patients with HHT: a pilot study. Rhinology. 2009 Mar. 47(1):85-8. [Medline].

  112. Bose P, Holter JL, Selby GB. Bevacizumab in hereditary hemorrhagic telangiectasia. N Engl J Med. 2009 May 14. 360(20):2143-4. [Medline].

  113. Massoud OI, Youssef WI, Mullen KD. Resolution of hereditary hemorrhagic telangiectasia and anemia with prolonged alpha-interferon therapy for chronic hepatitis C. J Clin Gastroenterol. 2004 Apr. 38(4):377-9. [Medline].

  114. Wheatley-Price P, Shovlin C, Chao D. Interferon for metastatic renal cell cancer causing regression of hereditary hemorrhagic telangiectasia. J Clin Gastroenterol. 2005 Apr. 39(4):344-5. [Medline].

  115. Lupu A, Stefanescu C, Treton X, Attar A, Corcos O, Bouhnik Y. Bevacizumab as rescue treatment for severe recurrent gastrointestinal bleeding in hereditary hemorrhagic telangiectasia. J Clin Gastroenterol. 2013 Mar. 47(3):256-7. [Medline].

  116. Shovlin CL, Jackson JE, Bamford KB, Jenkins IH, Benjamin AR, Ramadan H, et al. Primary determinants of ischaemic stroke/brain abscess risks are independent of severity of pulmonary arteriovenous malformations in hereditary haemorrhagic telangiectasia. Thorax. 2008 Mar. 63(3):259-66. [Medline].

  117. Shovlin CL, Winstock AR, Peters AM, et al. Medical complications of pregnancy in hereditary haemorrhagic telangiectasia. QJM. 1995 Dec. 88(12):879-87. [Medline].

  118. Buscarini E, Plauchu H, Garcia Tsao G, White RI Jr, Sabbà C, Miller F, et al. Liver involvement in hereditary hemorrhagic telangiectasia: consensus recommendations. Liver Int. 2006 Nov. 26(9):1040-6. [Medline].

  119. Lerut J, Orlando G, Adam R, et al. Liver transplantation for hereditary hemorrhagic telangiectasia: Report of the European liver transplant registry. Ann Surg. 2006 Dec. 244(6):854-62; discussion 862-4. [Medline]. [Full Text].

  120. Thevenot T, Vanlemmens C, Di Martino V, et al. Liver transplantation for cardiac failure in patients with hereditary hemorrhagic telangiectasia. Liver Transpl. 2005 Jul. 11(7):834-8. [Medline].

  121. Mitchell A, Adams LA, MacQuillan G, et al. Bevacizumab reverses need for liver transplantation in hereditary hemorrhagic telangiectasia. Liver Transpl. 2008 Feb. 14(2):210-3. [Medline].

  122. Curie A, Lesca G, Cottin V, et al. Long-term follow-up in 12 children with pulmonary arteriovenous malformations: confirmation of hereditary hemorrhagic telangiectasia in all cases. J Pediatr. 2007 Sep. 151(3):299-306. [Medline].

 
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Typical manifestations in patient with Osler-Weber-Rendu disease (ie, hereditary hemorrhagic telangiectasia) with red nodules and starry telangiectasia on cheeks.
Close-up view of typical manifestations in patient with Osler-Weber-Rendu disease (ie, hereditary hemorrhagic telangiectasia) with red nodules and starry telangiectasia on lips.
Close-up view of typical manifestations in patient with Osler-Weber-Rendu disease (ie, hereditary hemorrhagic telangiectasia) with red nodules and starry telangiectasia on cheeks.
 
 
 
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