Episode # 646 • 19 May 2026
Embolization Techniques for Pulmonary AVMs: Expert Insights
Pulmonary AVM may be rare, but missing them can lead to lifelong complications, especially in patients with hereditary hemorrhagic telangiectasia (HHT). How do you choose the right device and strategy to ensure long-term success with embolization? In this episode of the BackTable Podcast, host Dr. Kavi Krishnasamy is joined by Dr. Brian Funaki and Dr. Nima Kokabi to unpack the evolving treatment landscape for pulmonary arteriovenous malformations (PAVM). Through imaging breakdown, review of challenging real-world cases, and a discussion on advanced treatment strategies, the conversation tackles a key debate in pulmonary embolization: are plugs replacing coils as the new standard?
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Timestamps
00:00 - Introduction
01:43 - Defining HHT and PAVM
05:53 - Democratizing Interventions for HHT Patients
08:83 - Recommendations to Embolize PAVM
13:19 - Imaging Specificity and Procedural Preferences
23:29 - Persistence Rates with Plugs and Coils
25:59 - Lag in Utilization of Plugs
29:18 - Comparison of LOBO to Alternative Vascular Plugs
34:26 - Post Embolization Symptoms and Troubleshooting Methods
39:04 - PAVM Cases and Treatments
54:26 - Wrap Up and Credits
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More about this episode
The discussion begins by defining HHT and PAVM, highlighting the risks associated with untreated PAVM and the critical need for genetic screening and multi-organ evaluation. Drs. Funaki and Kokabi review current treatment recommendations, surveillance imaging, and follow-up protocols, with special considerations for pediatric and high-risk patients. They explore practical tips for optimizing embolization performance, focusing on device selection and the evolving role of vascular plugs. By comparing different plug designs, such as wire count and pore size, and sharing lessons from challenging cases, including persistent lesions, tortuous anatomy, and pseudoaneurysm management, they provide advanced troubleshooting and decision-making strategies to achieve more durable, successful PAVM treatments.
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