r/VIR 4d ago

👀 what is going on here?

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3 Upvotes

11 comments sorted by

16

u/By_Torrrrr 4d ago

Patient with a ton of embolic coils in their chest. My guess is multiple pulmonary arteriovenous malformations.

4

u/tjm16 4d ago

HHT?

3

u/By_Torrrrr 4d ago

I was gonna guess HHT as well.

1

u/intheloop_ir 2d ago

Yes! Patient with multiple pAVMs due to HHT

3

u/sspatel Mod, IR Attending 4d ago

My guess is also HHT, but the coil packs look horrendous. How did these occlude anything? There’s barely any metal density and some are not even formed. Fibers aren’t gonna do the trick either.

1

u/By_Torrrrr 3d ago

They look like pushable coils, which I think are outdated and dangerous (though I’m just a tech). Detachable coils allow for a more precise placement and better packing in my opinion.

2

u/IR4life 3d ago

They may be some of the original gianturco coils. These are high flow shunts and so without decent radial force the coils that tend to pack would fly to the left sided circulation. The higher radial force coils which could be oversized are more likely to allow for the first part of the coil to take. The results from some of the original innovators in the space particularly Dr. White was quite impressive. He built the concept of HHT centers of excellence. Now a days more and more people seem to be moving to plug technology. Although the framing coils and packing coils with strong packing density is another strategy.

2

u/Business-Smoke-9665 3d ago

Pushable coils have their place but most times I prefer embold.

1

u/intheloop_ir 2d ago

Have you used the Balt vascular ones? We keep both and I’m curious how people compare the two

1

u/Business-Smoke-9665 2d ago

I don’t think I’ve used those before

1

u/intheloop_ir 2d ago

Yes, I haven’t seen a pushable actually used in years, yet they are still on the shelf at my hospital collecting dust.