Initial Experience With the Microvascular Plug in Selective Renal Artery Embolization

Abstract

Purpose: To evaluate the safety and efficacy of the microvascular plug (MVP) for selective renal artery embolization. Methods: Retrospective review was performed on a cohort of 6 patients undergoing renal artery embolization using the MVP between July 2015 and August 2018. Patients’ demographics, indication for embolization, technical details of the embolization procedure, and clinical events were gathered from the patients’ electronic medical records. Results: The patients underwent selective renal artery embolization with a MVP for iatrogenic vascular injuries (n = 3), traumatic vascular injuries (n = 2), and for elective embolization of an angiomyolipoma (n = 1), in native kidneys (n = 4) or in renal allografts (n = 2). Immediate occlusion of the feeding artery was achieved with 1 MVP device in 4 patients. In 1 patient, a second MVP was needed, and in another patient, additional 0.018-inch microcoils were used to completely occlude the injured artery. Technical success was achieved in all patients. The volume of the resulting renal infarction was estimated less than 5% of the renal volume. No other procedure-related complications occurred. Conclusion: The MVP is a safe and effective device allowing superselective renal artery embolization. Therefore, we recommend the MVP as a valuable embolic in superselective renal artery embolization. Additionally, a single device is sufficient in most cases, potentially reducing the cost, duration, and radiation exposure of the procedure.

Embolization with MVP (Micro Vascular Plug®): experience on 104 patients in emergent and elective scenarios

“…Published series have already demonstrated the effective occlusive property of MVP in both cranial (Kleine et al 2015;Carlson et al 2017;Burkhardt et al 2018;Shwe et al 2014;See et al 2017) and extracranial vascular embolization procedures (Boatta et al 2017;Conrad et al 2015;Ratnani et al 2019;Mahdjoub et al 2018;Duvnjak et al 2018;Bailey et al 2019;Barrett et al 2018;Giurazza et al 2018Giurazza et al , 2019; its applications included both emergent and elective conditions. Among others, multiple experiences about renal hemorrhages embolization reported satisfying results (Giurazza et al 2019;Jardinet et al 2020); they reported complete embolization with a single MVP in 80% and 66% respectively, these values being similar to the technical success rate reported in our study. Concerning the elective scenarios, MVP seems to present particular advantages for occlusion of pulmonary arteriovenous malformations (Boatta et al 2017;Bailey et al 2019;Barrett et al 2018;Conrad et al 2015;Duvnjak et al 2018;Mahdjoub et al 2018;Ratnani et al 2019), with technical success ranging between 91 and 100%.…”

“…The first experience description in literature is relatively recent, dated 2014 (Pellerin et al 2014); since then, few papers (Abdelsalam et al 2020;Bailey et al 2019;Barrett et al 2018;Boatta et al 2017;Conrad et al 2015;Duvnjak et al 2018;Giurazza et al 2019;Jardinet et al 2020;Mahdjoub et al 2018;Ratnani et al 2019), have reported on the use of MVP in interventional radiology focusing on small samples of patients, especially affected by pulmonary arteriovenous malformations.…”

The Common but Complicated Tool: Review of Embolic Materials for the Interventional Radiologist

“…53 Like the AVP, it is made of a nitinol frame; however, it uses a polytetrafluroethylene-covering instead of mesh to lead to occlusion. 53,54 It is detachable, via a microscrew, and has been described in several different clinical scenarios. 55,56 The design allows for excellent trackability and deliverability; however, it can also cause migration in high-flow situations.…”

Amplatzer vascular plug in renal artery embolization: case report and review of the literature

“…Although there are a small number of scientific works that describe the release of AVP in the embolization of the renal vessels, their use is becoming increasingly widespread and routine [2,4,5]. The embolization of the renal arteries represents the gold standard for acute bleeding; it is a valid support for the treatment of arteriovenous fistula and for the therapeutic management of large hypervascularized renal heteroplastic masses but it is strongly recommended also in cases of vascular malformations [1][2][3][4][5][6]. In pre-operative planning, knowledge of normal anatomy and renal artery variants found in 30% of the population is fundamental.…”

“…Renal artery embolization is an interventional radiology procedure that over the years has proven to be safe and effective in the treatment of numerous pathologies both in election and in urgency: active post-traumatic or post-biopsy bleeding, kidney tumors, arteriovenous fistula (FAV), and vascular malformation [1]. Over the years, numerous embolizing materials have been proposed: fibrin (temporary occlusion), glues, coils, and microspheres [1]. The plugs represent a vascular occlusion system initially used at the cardiological pathologies (foramen ovale or DIA occlusion) and extended in the peripheral area with the necessary structural changes.…”