Early Experience with the Amplatzer Vascular Plug II for Occlusive Purposes in Arteriovenous Hemodialysis Access

Abstract

The Amplatzer Vascular Plug Type II (AVP II) has proven effective in the therapeutic embolization of various vascular lesions. It benefits from very rapid occlusion of the target lesion and can be deployed, retrieved, and redeployed if required. There is no literature available on use of the AVP II in the maintenance, closure, and management of complicated arteriovenous access in hemodialysis patients. In this series, we present our clinical experience with the use of the AVP II for embolization of problematic hemodialysis access. The AVP II is a self-expandable Nitinol wire-mesh device. Mounted on a delivery wire it has the capability to be deployed, recaptured, and redeployed. In total seven patients (four males: one diabetic, all nonsmokers), with ages ranging from 44 to 81 years (mean, 63 years), were treated between July 2008 and January 2009. One patient had not started dialysis. The remaining six patients had varied histories, with the time on hemodialysis ranging from 1 to 21 years. Retrospective review of clinical notes revealed patient demographics, type of access, device size, deployment site, and outcomes. Indications for embolization included steal syndrome (one patient), high-flow tributaries (two patients), and limb swelling (four patients). All patients had clinical and sonographical follow-up to 3 months. Surgical ligation had either failed, was considered a contraindication due to concerns regarding wound healing, or was considered difficult due to complex venous anatomy. Only one device was used in each patient, ranging from 6 to 16 mm in diameter. Immediate technical success was seen in 100%. All these patients were followed up clinically in the vascular access radiology clinic at 4 weeks and 3 months. Occlusion of the treated vessel and resolution of symptoms were reconfirmed in 100% of cases at 3 months. It was also noted whether patients were having successful dialysis, if required. There were no complications. Average procedural time was 19 min. We conclude that the AVP II is an efficient, safe, and technically simple occlusion device for use in arteriovenous access.

Intraplug coils delivery for fast closure of giant arteriovenous fistulas (AVFs) aneurysm in dialyzed patient

“…Today, AVP has a wide use for extracardiac procedures such as arterial and venous embolization. Single cases of AVP use in embolization AVFs have also been reported [5], [8], [9]. To our knowledge only 3 cases of AVP use as a coil constrainer were described [5], [8], [9], and surely no cases of giant aneurysm.…”

Hemodialysis Arteriovenous Access Occlusion Using the Amplatzer Vascular Plug in Patients with Intractable Arm Edema

“…Powell et al [ 8 ] reported on 7 patients with complicated HD access who were treated with AVP. Their complex venous anatomy, wound healing, and severe local conditions made surgical ligation challenging.…”

Massive retroperitoneal hemorrhage from a giant renal angiomyolipoma treated by selective arterial embolization with an Amplatzer Vascular Plug II

“…There is a large body of literature on the application of the same AVP type II used in our case for various conditions: the occlusion of a spontaneous mesocaval shunt (15), to treat a type II endoleak after endovascular thoraco-abdominal aortic aneurysm repair (16, 17), and to occlude an arteriovenous hemodialysis access (18). Generally, the AVP should be oversized by approximately 20% of the vessel diameter.…”