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

Abstract

Objectives: Vascular occlusion of hemodialysis arteriovenous access (AVA) using an Amplatzer vascular plug (AVP; St. Jude Medical, St. Paul, MN, USA) is an arising and alternative practice in selected patients; however, few reported cases can be found in the literature. Herein, we report on our experience with endovascular treatment of complicated AVA. Materials and Methods: From September 2015 to December 2016, 3 patients at our clinic underwent an occlusion of hemodialysis AVA with 2 different Amplatzer vascular plugs: 2 patients with type II and 1 patient with type IV. Of these, 1 patient was treated for an autologous radiocephalic fistula, the second patient was treated for an autologous brachiocephalic fistula located at the elbow, and the third was, instead, treated for a radiocephalic forearm fistula. The reason for closing the AVA in all patients was due to the presence of dialysis-associated steal syndrome with critical hand ischemia and intractable ipsilateral edema. Results: All AVAs were treated using an AVP. No plug migration, access revascularization, persistent ischemia, nor other complications were observed. Conclusion: This report suggests that the use of AVP for embolization of complicated AVA is a safe and reasonable alternative to open surgery in selected patients.

Endovascular embolization in problematic hemodialysis arteriovenous fistulas: A nonsurgical technique

“…have mentioned successful closure of AVF in three patients of dialysis-associated steal syndrome with critical hand ischemia and intractable ipsilateral edema using Amplatzer vascular plug (AVP; St. Jude Medical, St. Paul, MN, USA). [ 9 ]…”

“…Patients with symptoms of VH present with extensive swelling of ipsilateral extremity and chest along with skin changes (skin discoloration, puckering, and thickening): Posing a surgical challenge to detect and ligate the fistula. [ 9 ] In situations where a precious high flowing problematic AVF cannot be sacrificed, flow reduction procedures can be used as they preserve access functionality. [ 10 ]…”

Endovascular closure of an arterivenous graft for dialysis-associated steal syndrome of lower extremity

“…If closure of the fistula becomes necessary, surgical ligation of arteriovenous fistula is the conventional approach; however, recent progress with endovascular experience has made closure with the Amplatzer Vascular Plug another alternative. The Amplatzer Vascular Plug has been used in the upper extremity for cases that required AVF closure due to DASS, heart failure, and central venous occlusion [ 2 , 3 , 9 ]. The same device can be used to treat DASS in the lower extremity as presented in our case.…”

“…The Amplatzer Vascular Plug (St. Jude Medical, St. Paul, MN) is utilized for endovascular closure of AVF and the success of this intervention for upper extremities are reported in the literature [ 2 , 3 ]. We report a successful endovascular closure of a lower extremity AVF with a graft between the femoral artery and vein due to DASS of the lower extremity of a patient with a high surgical risk.…”

The use of the Amplatzer Vascular Plug in the prevention of endoleaks during abdominal endovascular aneurysm repair: A systematic literature review on current applications

“…The AVP device is used in the occlusion of medium and large vessels but has multiple uses beyond the occlusion of vessels to prevent endoleaks during EVAR. [7][8][9] There are 4 models on the market and all models consist of 2 components: the plug itself and a delivery wire. The plug is made with nitinol interweave, giving it a self-expanding property.…”