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Pulmonary Arteriovenous Malformations and Hereditary Hemorrhagic Telangiectasia: Embolotherapy Using Balloons and Coils-Reply

Tjeerd Haitjema, MD, PhD; Cornelius J. J. Westermann, MD, PhD; Thimotheus T. C. Overtoom, MD
Arch Intern Med. 1996;156(22):2628. doi:10.1001/archinte.1996.00440210159021.
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We thank White for his remarks. He questions our statement that we prefer coils over balloons when embolizing PAVMs. Our view is based on the experience of Puskas et al,1 who describe recanalization of a PAVM after balloon embolization in 3 patients. In these patients, the balloons could not be identified on follow-up chest radiographs. When 1 of the 3 patients subsequently underwent resection of the PAVM, the balloon could not be found in the surgical specimen. In the 2 other patients, there was no clue as to whether the balloon(s) is still embedded in a thrombus in the pulmonary artery or has migrated to the systemic circulation. Furthermore, we also treated a patient with balloon embolization in whom deflation and migration of the balloon occurred 4 days after embolization.2 This balloon was located in the hepatic artery, without causing complications. We have not had this experience with


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