Emergency Radiology

, Volume 15, Issue 3, pp 153–160 | Cite as

Use of Amplatzer Vascular Plug (AVP) in emergency embolisation: preliminary experience and review of literature

  • Monica Mangini
  • Domenico Laganà
  • Federico Fontana
  • Andrea Ianniello
  • Paolo Nicotera
  • Maria Petullà
  • Gianpaolo Carrafiello
  • Carlo Fugazzola
Original Article

Abstract

Amplatzer Vascular Plug (AVP) is a device recently proposed for extra-cardiac procedures such as arterial and venous embolisation. In this paper, we assess the usefulness of AVP in emergency embolisation presenting our preliminary experience and reviewing the Literature. During the last year, we selected 31 patients for embolisation using AVP. The following nine procedures were performed in emergency (8 males, mean 72.4 years, range 57–85): four ruptured abdominal aortic aneurysm, one traumatic hepatic pseudoaneurysm with arterio-portal fistula, one carotid pseudoaneurysm due to neoplastic erosion, one renal tumor with active bleeding, one ruptured isolated iliac aneurysm and one ruptured hypogastric aneurysm. We used a total of 13 AVPs. The follow-up was carried out by computed tomography angiography (CTA) and/or contrast-enhanced ultrasound (CEUS), 3 months after the procedure and then every 3 months. We obtained immediate technical success in all nine cases. No rupture or dissection of the treated arteries occurred. We observed only an asymptomatic spasm. During a mean follow-up of 5.3 months (range 3–12 months), CTA and/or CEUS showed complete occlusion of the treated arteries. The AVP is useful in some emergency settings. In the authors’ experience, the device allows precise, controlled release and can be deployed to the target more rapidly than other traditional methods. The device cannot be used in all patients due to limited ability to negotiate tortuous vessels and limited size availability. In our institution, the AVP is less expensive than alternatives. In our experience and as reported in the early literature, the device is easy to use, versatile, and achieved a high technical success rate. Further studies may confirm the effectiveness and demonstrate additional indications.

Keywords

Interventional radiology Vascular plug Embolisation Emergency 

References

  1. 1.
    Wang JK, Tsai SK, Wu MH, Lin MT, Lue HC (2004) Short- and intermediate-term results of transcatheter closure of atrial septal defect with the Amplatzer Septal Occluder. Am Heart J 148:511–517PubMedCrossRefGoogle Scholar
  2. 2.
    Santoro G, Bigazzi MC, Palladino MT, Russo MG, Carrozza M, Calabrò R (2004) Comparison of percutaneous closure of large patent ductus arteriosus by multiple coils versus the Amplatzer duct occluder device. Am J Cardiol 94:252–255PubMedCrossRefGoogle Scholar
  3. 3.
    Kessler J, Trerotola SO (2006) Use of the Amplatzer Vascular Plug for embolization of a Retroperitoneal Shunt during Transjugular intrahepatic portosystemic shunt creation for gastric variceal bleeding. JVIR 17:135–140PubMedGoogle Scholar
  4. 4.
    Cil B, Canyigit M, Ozkan OS, Pamuk GA, Dogan R (2006) Bilateral multiple pulmonary arteriovenous malformations: endovascular treatment with the Amplatzer vascular plug. JVIR 17:141–145PubMedGoogle Scholar
  5. 5.
    Hoit DA, Schirmer CM, Malek AM (2006) Use of the Amplatzer vascular plug as an anchoring scaffold for coil-mediated parent vessel occlusion: technical case report. Neurosurgery 59:171–172CrossRefGoogle Scholar
  6. 6.
    Dorenberg EJ, Hafsahl G, Andersen R, Krohg-Sorensen K (2006) Recurrent rupture of a hypogastric aneurysm caused by spontaneous recanalization of an Amplatzer vascular plug. J Vasc Interv Radiol 17:1037–1041PubMedGoogle Scholar
  7. 7.
    Rossi M, Rebonato A, Greco L, Stefanini G, Citone M, Speranza A et al (2006) A new device for vascular embolization: report on case of two pulmonary arteriovenous fistulas embolization using the amplatzer vascular plug. Cardiovasc Intervent Radiol 29:902–906PubMedCrossRefGoogle Scholar
  8. 8.
    Hoppe H, Hohenwalter EJ, Kaufman JA, Petersen B (2006) Percutaneous treatment of aberrant right subclavian artery aneurysm with use of the Amplatzer septal occluder. J Vasc Interv Radiol 17:889–894PubMedCrossRefGoogle Scholar
  9. 9.
    Beck A, Dagan T, Matitiau A, Bruckheimer E (2006) Transcatheter closure of pulmonary arteriovenous malformations with amplatzer devices. Catheter Cardiovasc Interv 67:932–937PubMedCrossRefGoogle Scholar
  10. 10.
    Mylonas I, Sakata Y, Salinger MH, Feldman T (2006) Successful closure of a giant true saphenous vein graft aneurysm using the Amplatzer vascular plug. Catheter Cardiovasc Interv 67:611–616PubMedCrossRefGoogle Scholar
  11. 11.
    Ha CD, Calcagno D (2005) Amplatzer Vascular Plug to occlude the internal iliac arteries in patients undergoing aortoiliac aneurysm repair. J Vasc Surg 42:1058–1062PubMedCrossRefGoogle Scholar
  12. 12.
    Pate GE, Carere RG (2005) Percutaneous occlusion of a pulmonary aneurysm causing hemoptysis in a patient with pulmonary atresia and aortopulmonary collaterals. Catheter Cardiovasc Interv 65:310–312PubMedCrossRefGoogle Scholar
  13. 13.
    Ferro C, Rossi UG, Bovio G, Seitun S, Rossi GA (2007) Percutaneous transcatheter embolization of a large pulmonary arteriovenous fistula with an amplatzer vascular plug. Cardiovasc Intervent Radiol 30:328–331PubMedCrossRefGoogle Scholar
  14. 14.
    de Medici L, Bucci F, Nesi F, Rabitti G (2006) Embolization of isolated hypogastric artery aneurysm: a case report and a review of the literature. Cardiovasc Intervent Radiol 29:893–896PubMedCrossRefGoogle Scholar
  15. 15.
    Pattynama PM, Wils A, van der Linden E, van Dijk LC (2007) Embolization with the Amplatzer Vascular Plug in TIPS patients. Cardiovasc Intervent Radiol 30:1218–1221PubMedCrossRefGoogle Scholar
  16. 16.
    Andersen PE, Kjeldsen AD (2007) Occlusion of pulmonary arteriovenous malformations by use of vascular plug. Acta Radiol 48:496–499PubMedCrossRefGoogle Scholar
  17. 17.
    Tuite DJ, Kessel DO, Nicholson AA, Patel JV, McPherson SJ, Shaw DR (2007) Initial clinical experience using the Amplatzer Vascular Plug. Cardiovasc Intervent Radiol 30:650–654PubMedCrossRefGoogle Scholar
  18. 18.
    Idowu O, Barodawala F, Nemeth A, Trerotola SO (2007) Dual use of an amplatzer device in the transcatheter embolization of a large high-flow renal arteriovenous fistola. J Vasc Interv Radiol 18:671–676PubMedCrossRefGoogle Scholar
  19. 19.
    Ferro C, Petrocelli F, Rossi UG, Bovio G, Dahmane M, Seitun S (2007) Vascular percutaneous transcatheter embolisation with a new device: Amplatzer vascular plug. Radiol Med 112:239–251CrossRefPubMedGoogle Scholar
  20. 20.
    Masura J, Walsh KP, Thanopoulous B, Chan C, Bass J, Goussous Y et al (1998) Catheter closure of moderate- to large-sized patent ductus arteriosus using the new Amplatzer duct occluder: immediate and short-term results. J Am Coll Cardiol 15(31):878–882CrossRefGoogle Scholar
  21. 21.
    Carrafiello G, Laganà D, Dizonno M, Mangini M, Fugazzola C (2007) Endovascular ligature of splenic artery aneurysm with Amplatzer Vascular Plug: a case report. Cardiovasc Revasc Med. 8:203–206PubMedCrossRefGoogle Scholar
  22. 22.
    Rabenstein T, Boosfeld C, Henrich R, Ell C (2006) First use of ventricular septal defect occlusion device for endoscopic closure of an esophagorespiratory fistula using bronchoscopy and esophagoscopy. Chest 130:906–909PubMedCrossRefGoogle Scholar
  23. 23.
    Sugiu K, Katsumata A, Kusaka N, Sasahara W, Tokunaga K, Martin JB et al (2004) Combined use of electrolytically and mechanically detachable platinum coils for endovascular treatment of cerebral aneurysm. Neurol Med Chir 44:269–274CrossRefGoogle Scholar
  24. 24.
    Lagana D, Carrafiello G, Mangini M, Dionigi G, Caronno R, Castelli P et al (2006) Multimodal approach to endovascular treatment of visceral artery aneurysms and pseudoaneurysms. Eur J Radiol 59:104–111PubMedCrossRefGoogle Scholar
  25. 25.
    Lagana D, Carrafiello G, Mangini M, Fontana F, Caronno R, Castelli P et al (2006) Emergency endovascular treatment of abdominal aortic aneurysms: feasibility and results. Cardiovasc Intervent Radiol 29:241–248PubMedCrossRefGoogle Scholar

Copyright information

© Am Soc Emergency Radiol 2007

Authors and Affiliations

  • Monica Mangini
    • 1
  • Domenico Laganà
    • 1
  • Federico Fontana
    • 1
  • Andrea Ianniello
    • 1
  • Paolo Nicotera
    • 1
  • Maria Petullà
    • 1
  • Gianpaolo Carrafiello
    • 1
  • Carlo Fugazzola
    • 1
  1. 1.Vascular and Interventional Radiology, Department of RadiologyUniversity of InsubriaVareseItaly

Personalised recommendations