The Amplatzer vascular plug for large vessel occlusion in the endovascular management of aneurysms

Abstract

The Amplatzer vascular plug (AVP) is derived from the Amplatzer device used in correction of cardiac septal defects. We present a large series of the use of the AVP in the endovascular management of aneurysms. Three patients with a combination of aortic and peripheral aneurysms underwent embolisation with the AVP. Plugs with 10-16 mm diameter were used and delivered using introducer/guiding sheaths. A total of 16 internal iliac arteries, 2 common iliac arteries (CIA), 4 subclavian (SCA) arteries, 1 superior mesenteric (SMA) and 1 popliteal artery were embolised. Successful occlusion with the AVP was achieved in 21 out of 24 vessels (87.5%), of which 18 (75%) occluded immediately and 3 (12.5%) were delayed occlusions. The three patients who are considered to have failed to occlude with the AVP required the use of additional embolic agents. At the end of the 17-month follow-up all 24 target vessels had occluded. Two patients developed persistent buttock claudication, and one had a left hemiparesis. The AVP is useful as an adjunctive device in the management of aneurysms. It has a particular role in embolisation of large-diameter vessels with a short implantation zone. The device is safe and easy to use.

How to Occlude a Side Branch on a Branched Stent-Graft During an Endovascular Thoracoabdominal Aortic Aneurysm Repair

“…Rather than coils, we selected the Amplatzer Vascular Plug II, which has been used to occlude septal communications, fistulas, and hypogastric and subclavian arteries during endovascular repair of aortic aneurysms. [4][5][6][7][8][9][10][11][12][13][14] Although it may seem contradictory to use a custom-made device in a patient for whom it was not designed, experience has taught that there is room for a certain amount of variation in positioning when it comes to branched stentgrafts, since there are many anatomical similarities between the visceral arteries. 2,15 As Chuter's group 15 proposed recently, the device described here could probably soon serve as the basis for a ''standardized'' multi-branched TAAA stent-graft, eliminating the wait for a customized endograft to be made.…”

Traumatic high flow vertebral-venous fistula presenting with delayed ischemic stroke: endovascular management with detachable coils and Amplatzer Vascular Plugs

“…Recently, however, as detachable balloons have become unavailable in the US, the Amplatzer Vascular Plug has been reported as having potential utility in neurointerventional procedures. 3,4,8,[10][11][12][13] It provides a relatively costeffective way to occlude parent arteries or abnormal fistulous connections in cases in which a large number of coils might otherwise be required. One potential drawback of the Amplatzer Vascular Plug is the attendant risk of thromboemboli, as it may take up to 30 minutes to completely occlude blood flow, and its porous nature may allow for clots to escape from the plug.…”

A novel endovascular occlusion device with a steerable introducer for embolization in a porcine model

“…New advanced occlusion devices have already been used as a therapeutic alternative to coil embolization in certain cases . For example, vascular plug has become an essential tool in a variety of clinical settings such as the treatment of arterio‐venous malformations, subclavian and internal iliac artery (IIA) occlusion in endovascular aneurysm repair (EVAR), and peripheral aneurysms where maintenance of vascular continuity is not a priority . It is reported that single occlusion device can occlude large arterial trunks, thus decreasing procedure length , the amount of contrast medium necessary, and the patient's radiation dose .…”

“…It is reported that single occlusion device can occlude large arterial trunks, thus decreasing procedure length , the amount of contrast medium necessary, and the patient's radiation dose . In addition, the precise deployment of the new device and its effective anchor preclude frustrating incidences of distal embolization and malperfusion that are more common in coil deployment Despite these advantages, the use of a large introducer/guiding sheath may be a limiting factor in vascular plug use as it is not always feasible to position a sheath at the site of embolization in highly tortuous arteries . In addition, the relatively long occlusion time has been mentioned as a concern .…”

“…In addition, the precise deployment of the new device and its effective anchor preclude frustrating incidences of distal embolization and malperfusion that are more common in coil deployment Despite these advantages, the use of a large introducer/guiding sheath may be a limiting factor in vascular plug use as it is not always feasible to position a sheath at the site of embolization in highly tortuous arteries . In addition, the relatively long occlusion time has been mentioned as a concern . A novel transcatheter occlusion device with a steerable introducer sheath that facilitates the device to be advanced to an anatomically hostile position, would be a major advance.…”