Evolving strategies in pulmonary arteriovenous malformation embolization

Pulmonary arteriovenous malformations (PAVMs) cause right-to-left shunting with risks of hypoxemia and paradoxical embolization. Endovascular embolization is the standard treatment, but long-term durability depends on anatomy, flow characteristics, device selection, embolization strategy, and follow-up definitions. This narrative review synthesizes contemporary evidence on embolic devices-including coils, vascular plugs, microvascular plugs, low-profile braided occluders, and liquid embolics-along with adjunctive techniques such as balloon occlusion, nidus-directed embolization, and cone-beam CT guidance. Available retrospective data suggest that plug-based strategies may be associated with lower persistence in anatomically suitable lesions, whereas coils, liquid embolics, and hybrid approaches remain important for complex, recurrent, or anatomically constrained lesions. Emphasis is placed on an anatomy-, flow-, and imaging-based decision framework, cautious interpretation of heterogeneous evidence, and structured long-term surveillance to minimize persistence and optimize clinical outcomes.