Bioptome-assisted coil closure of large pulmonary arteriovenous malformations

Large pulmonary arteriovenous malformations (AVMs) with feeding vessels larger than 5 mm cause significant right-to-left shunt resulting in cyanosis and need to be occluded as soon as they are diagnosed. Occlusion of such AVMs by simultaneous delivery of multiple coils was attempted in five patients and was successful in completely occluding the AVM in four of them. One patient had transient chest pain during the procedure, presumably as a result of coronary air embolism. A bioptome was used to hold the multiple coils together for optimal deployment and controlled release of the coils.