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Inferior Mesenteric Artery Embolization Before Endovascular Aortic Aneurysm Repair Using Amplatzer Vascular Plug Type 4

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Abstract

Purpose

This study was designed to evaluate the efficacy and safety of Amplatzer Vascular Plug type 4 (AVP-4) for embolization of the inferior mesenteric artery (IMA) before endovascular aneurysm repair (EVAR) of the abdominal aorta to prevent endoleaks.

Methods

A single-center retrospective review of 31 patients who underwent IMA embolizations before EVAR using the AVP-4 was performed. We analyzed the insertion and detachment procedure, the technical success, and the final position of the plug. Technical success was defined as complete occlusion of the IMA. To compare the incidence of IMA-related type II endoleaks in patients with and without preoperative IMA embolization, we additionally reviewed the course of 43 patients with a preoperatively patent IMA who underwent no IMA embolization.

Results

Plugs with a diameter of 5, 6, and 8 mm were used in 5 (16.1 %), 21 (67.7 %), and 5 (16.1 %) patients, respectively (50–100 % oversizing). In 29 of 31 patients (93.5 %), we observed complete occlusion of the IMA within 10 min (mean 5.1 min). Precise placement of the plug in the proximal segment of the IMA without occlusion of the first IMA branches was achievable in all patients. The distance between the AVP-4 and the first branches was on average 12 (range 2–57) mm. Preoperative IMA embolization with AVP-4 significantly reduced the incidence of complex IMA-lumbar type II endoleaks after EVAR (0/31 vs. 11/43; p = 0.002).

Conclusions

The AVP-4 is a safe, feasible, and technically effective embolization device for IMA embolization before EVAR.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany

    René Müller-Wille, Wibke Uller, Holger Gößmann, Peter Heiss, Philipp Wiggermann, Marco Dollinger, Christian Stroszczynski & Walter A. Wohlgemuth

  2. Department of Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany

    Piotr Kasprzak & Karin Pfister

Authors
  1. René Müller-Wille
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  2. Wibke Uller
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  3. Holger Gößmann
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  4. Peter Heiss
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  5. Philipp Wiggermann
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  6. Marco Dollinger
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  7. Piotr Kasprzak
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  8. Karin Pfister
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  9. Christian Stroszczynski
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  10. Walter A. Wohlgemuth
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Correspondence to René Müller-Wille.

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Müller-Wille, R., Uller, W., Gößmann, H. et al. Inferior Mesenteric Artery Embolization Before Endovascular Aortic Aneurysm Repair Using Amplatzer Vascular Plug Type 4. Cardiovasc Intervent Radiol 37, 928–934 (2014). https://doi.org/10.1007/s00270-013-0762-4

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  • DOI: https://doi.org/10.1007/s00270-013-0762-4

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