Percutaneous occlusion of the left subclavian and celiac arteries before or during endograft repair of thoracic and thoracoabdominal aortic aneurysms with detachable nitinol vascular plugs.
OBJECTIVE
To review an experience with the Amplatzer vascular plug (AVP) for prevention of type II endoleaks during endovascular aneurysm repair (EVAR) of thoracic and thoracoabdominal aneurysms.


METHODS
Retrospective review was undertaken of 14 patients undergoing transcatheter occlusion of the left subclavian (n = 12) or celiac artery (n = 2) with the AVP as part of EVAR of thoracic and thoracoabdominal aneurysms at a single institution. Procedural criteria evaluated were success at target vessel occlusion, the number of AVPs used, use of adjunctive embolization devices, and embolization-related ischemic end-organ events. Follow-up imaging criteria included evaluation of persistent target vessel occlusion, evidence of device migration, and the presence and characterization of endoleak secondary to AVP failure.


RESULTS
Complete target vessel occlusion was documented for all cases. In six cases, more than one AVP was placed, with an average of 1.5 devices per patient. In two cases, adjunctive coils were placed. Computed tomographic or magnetic resonance angiography follow-up was available for all patients (mean follow-up, 419 days; range 28-930 d). No case showed evidence of device migration or type II endoleak resulting from AVP failure. There was a single instance of left subclavian artery recanalization without type II endoleak. There were no embolization-related ischemic end-organ events.


CONCLUSIONS
Transcatheter arterial occlusion of the subclavian and celiac arteries with the AVP is a valuable adjunct to endografting in cases in which side branch embolization is necessary to extend the landing zone.
Tholpady
Ashok
A
Department of Radiology, University of Virginia Health System, Box 800170, Lee Street, Charlottesville, VA 22908, USA.
Hendricks
Daniel E
DE
Bozlar
Ugur
U
Turba
Ulku C
UC
Sabri
Saher S
SS
Angle
John F
JF
Arslan
Bulent
B
Cherry
Kenneth J
KJ
Dake
Michael D
MD
Matsumoto
Alan H
AH
Saad
Wael E A
WE
Park
Auh Whan
AW
Bonatti
Hugo
H
Hagspiel
Klaus D
KD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D017545:Aortic Aneurysm, Thoracic; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D002445:Celiac Artery / Q000601:surgery*; D020878:Device Removal; D005260:Female; D006801:Humans; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control* / Q000601:surgery; D013348:Subclavian Artery / Q000601:surgery*; D016896:Treatment Outcome
D000497:Alloys; C013616:nitinol