title: Amplatzer vascular plug for occlusion or flow reduction of hemodialysis arteriovenous access.
abstract: OBJECTIVE
  Use of the Amplatzer vascular plug (AVP; St. Jude Medical Inc, St. Paul, Minn) for percutaneous occlusion of a hemodialysis arteriovenous access (AVA) is an emerging practice, and only a few reports by radiologists have been published. We report here a multidisciplinary experience of this technique not only for AVA occlusion but also for flow reduction in selected patients.
  
  
  METHODS
  This preliminary study includes a series of 20 plugs of different generations (I, II, and IV) used in 19 hemodialysis patients (two children, 17 adults). Of these, 15 AVAs were autologous fistulas located at the elbow, 4 were autologous forearm fistulas, and 1 was a brachial-basilic polytetrafluoroethylene graft. AVP deployment was through a 4F to 8F sheath, with oversizing from 30% to 50% to reduce the risk of migration. AVA occlusion (n = 14), by placing the AVP in the vein at its origin, was performed for central vein occlusion after unsuccessful percutaneous recanalization (n = 4), high flow (n = 2), hand ischemia (n = 3), successful kidney transplant (n = 1), and brachial-basilic or brachial-brachial fistula second-stage superficialization technical failure (n = 4). Vein/polytetrafluoroethylene grafts were not removed. AVA flow reduction (n = 6), by placing the AVP in the radial artery, was performed for well-tolerated high flow (n = 3) or high flow associated with distal ischemia (n = 3). All patients underwent a postoperative evaluation at 6-month intervals that included a clinical examination and duplex scan.
  
  
  RESULTS
  AVA occlusion or flow reduction was successfully achieved in all patients. Ischemia persisted in one patient and a revascularization with a distal bypass was necessary. Mean follow-up was 1.2 ± 0.8 years (range, 2 months-2.9 years). No plug migration, access revascularization, or other complication was observed.
  
  
  CONCLUSIONS
  The results of this short preliminary study suggest that plug insertion for occlusion or for flow reduction in a hemodialysis AVA constitutes a reasonable alternative to coil insertion or to open surgery in selected patients.
authors.affiliation: Vascular Surgery Department, Clinique Jouvenet, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bourquelot
authors.affiliation: Vascular Surgery Department, Clinique Jouvenet, Paris, France.
authors.forename: Lamisse
authors.initials: L
authors.lastname: Karam
authors.affiliation: Interventional Angiography Department, Clinique Alleray-Labrouste, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Raynaud
authors.affiliation: Interventional Angiography Department, Clinique Alleray-Labrouste, Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Beyssen
authors.affiliation: Department of Vascular Surgery, Hôpital Jean-Bernard, University of Poitiers, Poitiers, France. Electronic address: jeanbaptistericco@gmail.com.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Ricco
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002675:Child, Preschool; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D011859:Radiography; D012039:Regional Blood Flow; D006435:Renal Dialysis; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*