Table 1

Summary of Good Practice Points

Topic	Subtopic	Summary
1. Embolisation	All	Refer all if technically feasible.
2. Medical management (DIPPSSOH)	Dental	Antibiotic prophylaxis for all (also for surgery).
	Iron	Treatment of iron deficiency may be required even if haemoglobin and ferritin in the normal range.
	Pregnancy	Inform that pregnancies are designated ’high-risk', with a recent maternal death rate of 1%.
	Polycythaemia	Consider venesection only if there are symptoms of hyperviscosity.
	Scuba	Inform that decompression illness is more common and severe.
	Stroke	Thrombolysis is not recommended. Consider brain abscess.
	Oxygen	Hypoxaemia is usually asymptomatic, and there is no indication for routine use of supplementary oxygen.
	Pulmonary hypertension	Rare, usually due to hepatic AVMs/anaemia, and relative contraindication for embolisation.
3. Assess/manage underlying HHT	General	Screening should be conducted only after informed, pretest counselling.
	Nosebleeds	All patients should be provided with advice on nosebleed management if relevant.
	Iron	All patients with known or suspected HHT should be screened for iron deficiency anaemia.
	Pulmonary AVMs	All patients with known or suspected HHT should be offered the opportunity of a screen for PAVMs.
	Cerebral AVMs	While symptomatic patients should be investigated, based on current information, there appears to be only a limited role for routine screening for cerebral AVMs in asymptomatic patients.
	Hepatic AVMs	Screening of asymptomatic patients is not currently indicated.
4. Follow-up	CT use	In view of radiation exposure, follow-up CT should only be performed on the basis of an informed clinical decision.
	Natural history	Adults who have previously had a negative CT or contrast echocardiogram screen are unlikely to develop pulmonary AVMs.
	Post-embolisation	Follow-up is recommended approximately 6 months after treatment to assess clinical, physiological and radiological responses.

AVMs, arteriovenous malformations; HHT, hereditary haemorrhagic telangiectasia.