In Reply to: Re: Case 0998_09 -- Pulmonary Arteriovenous Malformation (PAVM) posted by Bret N Wiechmann on September 08, 1998 at 21:45:47:
Until we have a blood test, clinical history is the way to suspect HHT. He would appear to be a low risk for this. I would not screen his family as after all the questions he has been asked, anyone in his family who has a bleeding nose will front the doctor.
We use simple 035 fibred coils and place the first (big) one with the tip in the venous end and then deploy the rest of the coil back in the artery using a Davis tapered 5/6.5 French catheter from Cook. Subsequent small coils are packed around it in the artery. The stainless coils are more rigid than platinum and hold position well. In the few we have lost (in the systemic circulation) they have not shot off until we thought they looked good and let them go.
He does need to be followed to make sure this one stays shut and no others appear. Pulmonsry AVM's are often multiple. One cerebral abscess is enough.