The Amplatzer Vascular Plug: A Review of the Device and its Clinical Applications

Abstract

The Amplatzer Vascular Plug (AVP) is an established embolic device that can be an excellent alternative to coils or detachable balloons to embolize medium to large vessels with high flow. The device is easy to use and can be precisely deployed in the target vessel with high resistance to migration and a low recanalization rate. The technical success of this device is high, indications for use are expanding, and no absolute contraindications have been reported. Since its introduction, the AVP has grown from a single device to a group of 4 models (AVP, AVP II, AVP III, and AVP 4). Each model has a unique design and features that fit different vascular anatomies, hemodynamic situations, and clinical scenarios. Therefore, the new models cannot simply be treated as replacements for older ones. Unpredictable occlusion time remains a major shortcoming for the new models of the AVP. Large vessel size, high flow status, and coagulopathy can prolong the occlusion time, which can offset the cost benefit, reduced procedure time, and reduced radiation dose typically seen with use of the AVP alone. Coils or multiple AVPs can be used to expedite the occlusion process, and large Gelfoam particles also can be used as an adjunct to achieve rapid and reliable occlusion with minimal cost.

Micro Vascular Plug (MVP)-assisted vessel occlusion in neurovascular pathologies: technical results and initial clinical experience

“…The AMPLATZER plug is a resheathable, detachable device designed for precise targeted vessel occlusion and has been used with success 8. However, its use is limited to proximal cervical vessels owing to its slightly stiffer design and inability to track into smaller and tortuous branch vessels.…”

Preliminary Experience with Vascular Plugs for Parent Artery Occlusion of the Carotid or Vertebral Arteries

“…As mentioned above, the AVP is a self-expanding nitinol mesh cage and has been successfully used in a wide range of therapeutic applications 14). However, relatively few reports about the use of these devices in neuroendovascular fields have been published to date 6)8)9)10)11).…”

Amplatzer vascular plug IV for occlusion of pulmonary arteriovenous malformations in a patient with cryptogenic stroke

“…[34] The four types of AVPs (I-IV) were described in detail in a recent publication by Wang et al . [5] Hijazi first reported the use of the original AVP-I for closure of aortopulmonary collaterals. [6] In a series of 120 patients, use of the AVP-I resulted in successful embolization of 120 of 161 (75%) PAVMs without any significant complications.…”