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

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.

Applications of amplatzer® vascular plug 4

“…Therefore, in most cases, a single plug is sufficient for complete vessel occlusion. The use of one plug results in a significant reduction in the number of procedural steps, which in turn results in lower radiation exposure, reduced procedure time, and lower complication rates (1)(2)(3)(4)(5)(6)(7)(8).…”

“…The nontarget embolization risk of coils is reported to be 9%-23% (10,11). Three-dimensional volumetric coils with controlled release are an alternative in these cases; however, the cost of the procedure is higher (approximately $1,200), and electrolytic detachment is more time consuming (6). In contrast, theoretically, there is minimal risk of distal embolization or migration with the AVP 4.…”

“…It is therefore easier to precisely determine the configuration and location of the device and the occlusion of the vessel during control CT imaging. The AVP 4 can be visualized clearly using ultrasonography and is magnetic resonance imaging compatible (6).…”

“…The English literature describes the utility of the AVP 4 in renal pseudoaneurysm, postsurgical peritoneal bleeding, posttraumatic gluteal hemorrhage, intercostal pseudoaneurysm, and arteriovenous fistula after in situ saphenous vein bypass grafts (1)(2)(3)(4)(5)(6)(7)(8).…”

Applications of the Amplatzer Vascular Plug to various vascular lesions

“…It ensures permanent occlusion, and its migration risk is less than for coils. The results of embolization with the AVP have been excellent (2), and no contraindications for its use have been reported (3). All four types of AVP have two components: a vascular plug and a delivery wire.…”