Multi-case review of various applications of vascular plugs in embolization of high flow vascular lesions

Abstract

Introduction: The Amplatzer Vascular Plug (AVP) was created for peripheral embolization as a modification of the family of Amplatzer septal occluders used in the treatment of congenital heart malformations. The device has evolved over the years and multiple versions have been launched into the market. Immediate and accurate occlusion of high flow vascular malformations as well as their arterial feeders by usage sophisticated, advanced track able devices like such Avascular plug have added another tool to the armamentarium of the Interventional Radiologist. Vascular plugs are ideally suited to close extra-cardiac, high flowing vascular communications. Aims and Objectives: To study applications of vascular plugs in embolization of high flow vascular lesions. Materials and methods: Imaging proven cases of high flow vascular malformation were selected after written and informed consent. A patients were treated successfully with vascular plug after angiographic evaluation. Results: Ten embolization were performed of which 7 (70%) elective and 3 (30%) were done on emergency basis. Of these 7 cases 3 cases (42%) needed vascular plug and augmented with another embolic agents which includes coils in 1 case (16.6%)] and sterol in 2 cases (33.3%)]. Of the emergency 3 cases 2 (66.6%) needed plug with and adjunct embolic agent like gel foam in one case and coil in other. Conclusion: Successful embolization was performed in all cases. This includes pulmonary AVM, Dialysis fistula closure, Abernathy syndrome & portal hypertension. The vascular plug is a very useful embolization agent that allows the operator to treat a variety of high flow conditions including very challenging vascular lesions, such as high-flows AVF and vessels with short landing zones. There is good control on the device with minimal risk of distal embolization or migration. Becoming familiar with the different versions of the device within the AVP family and the utility of combining the AVP with other embolization therapies is very important.