Novel Technique for Intentional Occlusion of Directional Branches During Complex Endovascular Aortic Repair Using Microvascular Plugs

Abstract

Purpose To demonstrate the feasibility and outcomes of using the microvascular plug (MVP) for intentional occlusion of directional branches (DB) during complex endovascular aortic procedures. Case Report Two patients were treated with the off-the-shelf four-branched Zenith t-Branch thoracoabdominal stent-graft (Cook Medical, Bloomington, Ind). In both cases, the renal arteries (on one side in patient #1 and on both sides in patient #2, respectively) were occluded at time of index intervention. Preoperative planning included the intentional occlusion of each DB with one 7Q-MVP. Technical success was achieved in all cases and maintained at mid-term follow-up (12 months and 36 months, respectively). Conclusions Use of the MVP appears to be feasible and effective for intentional occlusion of DB during complex endovascular aortic repair. This novel and simple technique may present some unique technical advantages, allowing precise placement of the device while avoiding extension using a bridging stent and DB cannulation with larger sheaths.

Plug-Based Embolization Techniques of Aortic Side Branches during Standard and Complex Endovascular Aortic Repair

“…The MVP-7Q (MVP, Medtronic, Minneapolis, MN, USA) has also been used to occlude branches, with promising results in terms of early success and avoiding the use of a further bridging stent-graft, thus reducing overall procedural costs and possibly operating time [47] (Figure 6b). Aside from the economic and technical aspects, the -Alternatively, the "dog bone" technique [46] consists of deploying a balloon-expandable stent-graft inside the branch, sizing it 2 mm larger than the branch itself.…”

“…The MVP-7Q (MVP, Medtronic, Minneapolis, MN, USA) has also been used to occlude branches, with promising results in terms of early success and avoiding the use of a further bridging stent-graft, thus reducing overall procedural costs and possibly operating time [47] (Figure 6b). Aside from the economic and technical aspects, the MVP PTFE membrane design guarantees immediate vessel occlusion, which is of paramount importance in symptomatic/ruptured aneurysms, as opposed to the AVP II design which needs time to achieve complete branch thrombosis.…”