Abstract
Background
In palliated single ventricle patients aortopulmonary collateralization is a cause for significant loss of cardiovascular efficiency. In larger vessels, device occlusion becomes an alternative to embolization with multiple coils. The physical characteristics of the Amplatzer ™ Vascular Plug Type IV (AVPIV) are potentially conducive to oversizing the device allowing coverage of a longer portion of vessel. Despite the widespread use of the AVPIV, little published data exists describing the behavior of the device as it is constrained in different vessel sizes.
Methods
4–8 mm AVPIV devices were measured in glass tubing in diameters ranging from 1 to 8 mm internal diameter. Radial force was measured by constraining the devices to the desire diameters from 1 to 7 mm and measuring the force the device exerted to one of the constraining walls. This force vs. diameter relationship was evaluated for each device and compared across different devices.
Results
The devices range in length from 12.36 to 31.24 mm. The 4 mm device lengthened 3.44 mm from unconstrained to 1 mm diameter (12.36 to 15.80 mm), while the 8 mm AVP IV lengthened 14.74 mm from unconstrained to 1 mm diameter constraint (16.50–31.24 mm, 89% lengthening). The highest overall radial force (1.38 N), radial force at 50% compression (1.25 N), and average stiffness (0.95 N/mm) was found in the 5 mm diameter device.
Conclusions
The AVP IV device has a reliable length for diameter relationship. A counterintuitive property of the AVP IV with regards to radial force for device size was found. The 5 mm AVPIV was found to exert the highest radial force and stiffness compared to the other devices. The 7 and 8 mm AVPIV devices were consistently found to exert less radial force. This property suggests that oversizing an AVP IV could be safe and effective, potentially decreasing total devices used, cost, and overall procedure time.
Similar content being viewed by others
References
Adelmann, R., A. Windfuhr, G. Bennink, M. Emmel, and N. Sreeram. Extended applications of the Amplatzer vascular plug IV in infants. Cardiol Young 21(2):178–181, 2011.
Ascuitto, R. J., and N. T. Ross-Ascuitto. Systematic-to-pulmonary collaterals: a source of flow energy loss in Fontan physiology. Pediatr Cardiol 25(5):472–481, 2004.
Banka, P., L. A. Sleeper, A. M. Atz, et al. Practice variability and outcomes of coil embolization of aortopulmonary collaterals before Fontan completion: a report from the Pediatric Heart Network Fontan Cross-Sectional Study. Am Heart J 162(1):125–130, 2011.
Baruteau, A.-E., V. Lambert, J.-Y. Riou, C.-Y. Angel, E. Belli, and J. Petit. Closure of tubular patent ductus arteriosus with the Amplatzer Vascular Plug IV: feasibility and safety. World J Pediatr Congenit Heart Surg 6(1):39–45, 2015.
Bentham, J. R., and N. Wilson. Occlusion of anomalous systemic arterial supply in Scimitar syndrome using the new Amplatz vascular plug IV. Cardiol Young 20(3):349–350, 2010.
Bulla, K., S. Hubich, M. Pech, D. Löwenthal, J. Ricke, and O. Dudeck. Superiority of proximal embolization of the gastroduodenal artery with the Amplatzer vascular plug 4 before yttrium-90 radioembolization: a retrospective comparison with coils in 134 patients. Cardiovasc Intervent Radiol 37(2):396–404, 2014.
Bulut, M. O., İ. K. Yücel, Ş. Ballı, and A. Çelebi. Percutaneous transcatheter closure of a descending aorta to vertebral venous plexus fistula using an Amplatzer Vascular Plug 2: a case report. Turk Kardiyol Dernegi Arsivi Turk Kardiyol Derneginin Yayin Organidir 43(6):562–564, 2015.
Buttarelli, L., E. Capocasale, C. Marcato, M. P. Mazzoni, M. Iaria, and C. Rossi. Embolization of pancreatic allograft arteriovenous fistula with the Amplatzer Vascular Plug 4: case report and literature analysis. Transpl Proc 43(10):4044–4047, 2011.
Guneyli, S., C. Cinar, H. Bozkaya, M. Parildar, I. Oran, and Y. Akin. Successful transcatheter closure of a congenital high-flow portosystemic venous shunt with the Amplatzer vascular plug II. Perspect Vasc Surg Endovasc Ther 24(4):202–205, 2012.
Ishikawa, M., K. Kajiwara, W. Fukumoto, Y. Murakami, and K. Awai. Blood flow redistribution using the AMPLATZER vascular plug 4 before distal pancreatectomy with en bloc celiac axis resection. J Vasc Interv Radiol JVIR 27(2):285–286, 2016.
Kiefer, T. L., J. Vavalle, L. M. Hurwitz, G. C. Hughes, and J. K. Harrison. Resolution of severe hemolysis and paravalvular aortic regurgitation employing an Amplatzer Vascular Plug 4: the importance of detailed pre-procedural planning using CT angiography. Cardiovasc Intervent Ther 32(1):48–52, 2015.
Müller-Wille, R., W. Uller, H. Gössmann, et al. Inferior mesenteric artery embolization before endovascular aortic aneurysm repair using Amplatzer vascular plug type 4. Cardiovasc Intervent Radiol 37(4):928–934, 2014.
Ng, E. H., J. Comin, E. David, R. Pugash, and G. Annamalai. AMPLATZER Vascular Plug 4 for proximal splenic artery embolization in blunt trauma. J Vasc Intervent Radiol JVIR 23(7):976–979, 2012.
Perry, S. B., W. Radtke, K. E. Fellows, J. F. Keane, and J. E. Lock. Coil embolization to occlude aortopulmonary collateral vessels and shunts in patients with congenital heart disease. J Am Coll Cardiol 13(1):100–108, 1989.
Rossi, U. G., F. Petrocelli, and C. Ferro. Subclavian artery pseudoaneurysm complicating central venous catheterization: endovascular treatment with Amplatzer Vascular Plug 4 and covered stent. Catheter Cardiovasc Interv Off J Soc Card Angiogr Intervent 82(7):E906–E910, 2013.
Stern, H. J. Aggressive coiling of aortopulmonary collaterals in single-ventricle patients is warranted. Pediatr Cardiol 31(4):449–453, 2010.
Tau, N., E. Atar, M. Mei-Zahav, et al. Amplatzer vascular plugs versus coils for embolization of pulmonary arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia. Cardiovasc Intervent Radiol 39(8):1110–1114, 2016.
Whitehead, K. K., M. J. Gillespie, M. A. Harris, M. A. Fogel, and J. J. Rome. Noninvasive quantification of systemic-to-pulmonary collateral flow: a major source of inefficiency in patients with superior cavopulmonary connections. Circ Cardiovasc Imaging 2(5):405–411, 2009.
Wiegand, G., L. Sieverding, W. Bocksch, and M. Hofbeck. Transcatheter closure of abnormal vessels and arteriovenous fistulas with the Amplatzer vascular plug 4 in patients with congenital heart disease. Pediatr Cardiol 34(7):1668–1673, 2013.
Funding
No funding was obtained for this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All the authors declare that we have no conflict of interest.
Human and Animal Rights
This article does not contain any studies with human participants or animals performed by any of the authors.
Additional information
Associate Editor Ajit P. Yoganathan oversaw the review of this article.
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Zablah, J.E., Fry, R., Eilers, D. et al. The Length Versus Diameter Relationship and Radial Force Properties of the Amplatzer™ Vascular Plug Type IV: Observations for Oversizing. Cardiovasc Eng Tech 10, 271–276 (2019). https://doi.org/10.1007/s13239-019-00409-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13239-019-00409-2