I read with interest the excellent review article on hereditary hemorrhagic telangiectasia by Haitjema et al.1 I was in agreement with almost all their conclusions except for their choice of device for the treatment of pulmonary arteriovenous malformations (PAVMs).
Haitjema and colleagues prefer stainless steel coils over detachable balloons, "since balloons may slowly deflate" and have the "potential to migrate into the systemic circulation," thereby producing serious occlusion of a systemic artery. Detachable silicone balloons and stainless steel coils with Dacron fibers have been used for 17 years by interventional radiologists to close PAVMs, and my colleagues and I believe that both have an important role in providing safe and efficacious treatment.2 We have not observed late migration of a detachable silicone balloon or a coil once they are securely in place in the artery leading to a PAVM in any of the more than 250 patients whom
White RI. Pulmonary Arteriovenous Malformations and Hereditary Hemorrhagic Telangiectasia: Embolotherapy Using Balloons and Coils. Arch Intern Med. 1996;156(22):2627-2628. doi:10.1001/archinte.1996.00440210159020