{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T04:32:20Z","timestamp":1772166740259,"version":"3.50.1"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["CVIR Endovasc"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To assess how patients interpret and adhere to the International HHT Guidelines\u2019 recommendation to avoid intravenous (IV) air and to evaluate whether misinterpretation of this guidance as a strict requirement for in-line bubble filters may inadvertently hinder access to care. An anonymous 15-question survey was distributed to 7000 members of the HHT Research Network. The survey assessed awareness of the guideline, perceived necessity of bubble filter use, and the practical consequences of filter use. Responses were excluded if incomplete or submitted by individuals under 18\u00a0years old.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 596 responses received (9% response rate), 446 met inclusion criteria. Most respondents (79%) were aware of the guideline, and 66% interpreted it as requiring use of an IV bubble filter. Notably, 16% of respondents reported refusing care, and 25% reported delaying treatment\u2014most often patient-initiated\u2014due to perceived filter requirements. The interventions affected included essential and, in some cases, urgent care. In total, 20 respondents (4%) reported experiencing a transient ischemic attack (TIA) during IV therapy; two of these occurred despite filter use, and none resulted in permanent deficits. Patients who did not use filters were significantly less likely to report difficulty accessing care (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although the guideline advises caution in avoiding IV air, many patients interpret it as mandating bubble filter use. This misunderstanding has been linked to delays in necessary care, increased patient frustration, and limited treatment access. These findings underscore the importance of clearer communication and education around guideline intent to mitigate unintended consequences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42155-025-00620-4","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T01:09:29Z","timestamp":1764205769000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient interpretation and implementation of air embolism prevention guidelines in hereditary hemorrhagic telangiectasia (HHT): a survey-based study"],"prefix":"10.1186","volume":"8","author":[{"given":"Kimberly","family":"Wei","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Shamimi-Noori","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theodore G.","family":"Drivas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5463-5448","authenticated-orcid":false,"given":"Scott O.","family":"Trerotola","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"issue":"11","key":"620_CR1","doi-asserted-by":"publisher","first-page":"3329","DOI":"10.1161\/STROKEAHA.115.010984","volume":"46","author":"W Brinjikji","year":"2015","unstructured":"Brinjikji W, Iyer VN, Sorenson T, Lanzino G. Cerebrovascular manifestations of hereditary hemorrhagic telangiectasia. Stroke. 2015;46(11):3329\u201337.","journal-title":"Stroke"},{"issue":"2","key":"620_CR2","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1002\/humu.10026","volume":"19","author":"M Dakeishi","year":"2002","unstructured":"Dakeishi M, Shioya T, Wada Y, Shindo T, Otaka K, Manabe M, et al. Genetic epidemiology of hereditary hemorrhagic telangiectasia in a local community in the northern part of Japan. Hum Mutat. 2002;19(2):140\u20138.","journal-title":"Hum Mutat"},{"key":"620_CR3","doi-asserted-by":"crossref","unstructured":"Dunphy L, Talwar A, Patel N, Evans A. Hereditary haemorrhagic telangiectasia and pulmonary arteriovenous malformations. BMJ\u00a0Case Rep CP. 2021;14e238385","DOI":"10.1136\/bcr-2020-238385"},{"issue":"11","key":"620_CR4","doi-asserted-by":"publisher","first-page":"1217","DOI":"10.1164\/rccm.201407-1254CI","volume":"190","author":"CL Shovlin","year":"2014","unstructured":"Shovlin CL. Pulmonary arteriovenous malformations. Am J Respir Crit Care Med. 2014;190(11):1217\u201328.","journal-title":"Am J Respir Crit Care Med"},{"issue":"2","key":"620_CR5","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1136\/jmg.2005.030833","volume":"43","author":"SA Abdalla","year":"2006","unstructured":"Abdalla SA, Letarte M. Hereditary haemorrhagic telangiectasia: current views on genetics and mechanisms of disease. J Med Genet. 2006;43(2):97\u2013110.","journal-title":"J Med Genet"},{"issue":"2","key":"620_CR6","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1136\/jmg.2009.069013","volume":"48","author":"ME Faughnan","year":"2011","unstructured":"Faughnan ME, Palda VA, Garcia-Tsao G, Geisthoff UW, McDonald J, Proctor DD, et al. International guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia. 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Eur J Neurol. 2024;31(2):e16128.","journal-title":"Eur J Neurol"},{"issue":"3\u20134","key":"620_CR18","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1159\/000478734","volume":"44","author":"W Brinjikji","year":"2017","unstructured":"Brinjikji W, Nasr DM, Wood CP, Iyer VN. Pulmonary arteriovenous malformations are associated with silent brain infarcts in hereditary hemorrhagic telangiectasia patients. Cerebrovasc Dis. 2017;44(3\u20134):179\u201385.","journal-title":"Cerebrovasc Dis"},{"issue":"4","key":"620_CR19","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1017\/S1049023X21000649","volume":"36","author":"SJ Stratton","year":"2021","unstructured":"Stratton SJ. Population research: convenience sampling strategies. 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Anesth Analg. 2018;126(2):691\u20138.","journal-title":"Anesth Analg"}],"container-title":["CVIR Endovascular"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42155-025-00620-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42155-025-00620-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42155-025-00620-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T01:09:30Z","timestamp":1764205770000},"score":1,"resource":{"primary":{"URL":"https:\/\/CVIRendovasc.springeropen.com\/articles\/10.1186\/s42155-025-00620-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,27]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["620"],"URL":"https:\/\/doi.org\/10.1186\/s42155-025-00620-4","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-7376184\/v1","asserted-by":"object"}]},"ISSN":["2520-8934"],"issn-type":[{"value":"2520-8934","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,27]]},"assertion":[{"value":"22 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was considered IRB-exempt by the Institutional Review Board of the University of Pennsylvania (IRB# 854026).Informed consent was obtained from all individual participants included in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Consent for publication was obtained for every individual person\u2019s data included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"104"}}