Reply to Letter Regarding “Amplatzer Vascular Plugs Versus Coils for Embolization of Pulmonary Arteriovenous Malformations in Patients with Hereditary Hemorrhagic Telangiectasia”

Abstract

coils for transcatheter closure of pulmonary arteriovenous malformations (PAVMs) in HHT, we reported on the retrospective evaluation of available patient data and imaging. As with all retrospective studies, it has the inherent limitations of nonrandomization and patient selection bias.However, the patients who underwent a repeat pulmonary angiogram procedure did so for clinical reasons such as cyanosis or an increased amount of shunt [bubbles] on contrast echocardiogram or the presence of new PAVMs on a CT, and not just to evaluate the presence of recanalization. Many of these patients had multiple PAVMs embolized with coils or plugs in the same lung and therefore are acting as their own controls in a way.Our study suggests that Amplatzer plugs have a significantly lower recanalization rate than coils. As we have mentioned in our paper, the true recanalization rate of both coils and plugs can only be accurately assessed in a prospective randomized controlled study.

Optimizing the Interventional Approach for Embolization of Pulmonary Arteriovenous Malformations in Patients With Osler-Weber-Rendu Syndrome

“…Coil embolization of the feeding vessel has historically been the primary treatment of pulmonary AVMs with the anchor and scaffold technique [7]. However, this technique is limited by a significant rate of recanalization and adjacent vessel damage [7].…”

“…Coil embolization of the feeding vessel has historically been the primary treatment of pulmonary AVMs with the anchor and scaffold technique [7]. However, this technique is limited by a significant rate of recanalization and adjacent vessel damage [7]. Therefore, interventional radiologists have recently employed novel vascular plugs with or without coils, which has resulted in more successful long-term embolization [7].…”

“…However, this technique is limited by a significant rate of recanalization and adjacent vessel damage [7]. Therefore, interventional radiologists have recently employed novel vascular plugs with or without coils, which has resulted in more successful long-term embolization [7]. Recent studies have estimated recanalization rates when using vascular plugs to be as high as 7 percent, which is superior to a recent study listing coil recanalization rates as high as 33 percent in this setting [8].…”

“…The Amplatzer plug is a nitinol-based, self-expanding mesh that is advantageous in maneuverability, repositioning, and low risk for migration [6]. One disadvantage of vascular plugs is cost; however, this is somewhat mitigated due to the requirement of fewer plugs in comparison to coils for a given AVM embolization [7]. In addition, Amplatzer vascular plugs cannot be deployed through microcatheters and necessitate the use of at least 5 French catheters for deployment, limiting the use in small-caliber vessels.…”