ABSTRACT
<p>The objective of this case report was to evaluate the efficacy of the Plug Attachment Technique (PAT) with the Amplatzer Vascular Plug (AVP) in endovascular aneurysm repair (EVAR) in a case of ruptured abdominal aortic aneurysm (rAAA). An 84-year-old woman was taken by ambulance to our hospital. The enhanced CT scan showed an rAAA of 90 mm (Fitzgerald classification 3). The patient was immediately transferred to the operation room and treated with EVAR followed by the closing of the rupture cite using AVP, the Plug Attachment Technique (PAT). The total operation time was 158 min. The patient recovered uneventfully after the operation and was discharged 30 days after the onset. EVAR has been recognized as an efficient acute therapy in cases of rAAA internationally. However, in comparison with the conventional open surgery, we are often facing the critical complications after EVAR in case of rAAA, continuous bleeding thorough the rupture cite and acute compartment syndrome. Our Plug Attachment Technique (PAT) with the Amplatzer Vascular Plug (AVP) may not cause such complications and lead to improved results for EVAR in case of rAAA.</p>
ABSTRACT
OBJECTIVE: The purpose of this study was to report the authors' preliminary experience using the Amplatzer Vascular Plug (AVP) (St. Jude Medical, Plymouth, MN, USA) for parent artery occlusion of the internal carotid artery (ICA) or vertebral artery (VA). MATERIALS AND METHODS: Between September 2008 and December 2015, we performed 52 therapeutic parent artery occlusions (PAOs) by an endovascular technique. Among them, 10 patients underwent PAO of the carotid or vertebral arteries using AVPs. Clinical and radiographic data of these patients were retrospectively reviewed. RESULTS: The devices were used for VA dissection that presented with subarachnoid hemorrhage (SAH) in five patients, traumatic arteriovenous fistula (AVF) in two patients, spontaneous AVF in one patient, recurrence of carotid-cavernous fistula (CCF) in one patient, and symptomatic unruptured giant ICA aneurysm in one patient. The devices were used in conjunction with detachable and/or pushable coils and in the extracranial segments of the ICA or VA. Complete occlusion of the parent artery was achieved in all patients. There was one intra-procedural rupture of the VA dissection during coiling prior to using the device. CONCLUSION: Results from the current series suggest that the AVP might be used for therapeutic PAO in the extracranial segments of the ICA or VA.
Subject(s)
Humans , Aneurysm , Arteries , Arteriovenous Fistula , Carotid Artery, Internal , Endovascular Procedures , Fistula , Parents , Recurrence , Retrospective Studies , Rupture , Subarachnoid Hemorrhage , Vertebral ArteryABSTRACT
La fuga paravalvular es una complicación relevante después del cambio valvular quirúrgico. Tradicionalmente la cirugía ha sido considerada el tratamiento de elección, sin embargo, conlleva una elevada morbimortalidad, así como un incremento en el riesgo de desarrollar fuga paravalvular recurrente. El tratamiento percutáneo de la fuga paravalvular se presenta como una atractiva alternativa. Dicho tratamiento ha sido posible por la capacidad actual de integrar múltiples modalidades de imagen que han ayudado a definir la anatomía del defecto y a planificar y guiar el procedimiento de cierre percutáneo, resultando en mejores desenlaces. El Amplatzer® Vascular Plug III (St. Jude Medical) es el primer dispositivo específicamente diseñado para el cierre percutáneo de la fuga paravalvular con resultados prometedores. Presentamos la imagen ecocardiográfica transesofágica tridimensional del resultado exitoso de cierre percutáneo de una fuga paravalvular mitral residual con un dispositivo Amplatzer® Vascular Plug III (St. Jude Medical), después de un procedimiento inicial de cierre percutáneo con un dispositivo Amplatzer® Duct Occluder (St. Jude Medical).
Paravalvular leak is a significant complication after surgical valve replacement. Traditionally, redo surgery has been considered the treatment of choice, but is associated with high morbidity and mortality as well as increase risk of developing new leaks. Percutaneous treatment of paravalvular leak appears as an attractive alternative. Such treatment has been made possible by the current ability to integrate multiple imaging modalities that have helped to define the anatomy of the defect and planning and guiding the percutaneous closure procedure, thus resulting in better outcomes. The Amplatzer® Vascular Plug III (St. Jude Medical) is the first device specifically designed for percutaneous closure of paravalvular leak with promising results. We present the three-dimensional transesophageal echocardiographic images of a successful outcome of percutaneous closure of a residual mitral paravalvular leak with an Amplatzer® Vascular Plug III device (St. Jude Medical), after an initial procedure of percutaneous closure with an Amplatzer® duct occluder (St. Jude Medical).
Subject(s)
Humans , Male , Middle Aged , Echocardiography, Three-Dimensional , Echocardiography, Transesophageal , Heart Valve Prosthesis Implantation , Mitral Valve/surgery , Postoperative Complications/surgery , Postoperative Complications , Septal Occluder Device , Prosthesis DesignABSTRACT
No abstract available.
ABSTRACT
Coronary artery fistula draining into lung parenchymal vasculature has not been reported. Herein, we describe a case of an 81-year-old woman who presented with a localized pulmonary edema on right upper lobe associated with coronary fistula emptied into vasculature in right upper lobe. She underwent transcatheter closure of the fistula with an Amplatzer Vascular Plug 4, which resulted in complete occlusion and improved localized pulmonary edema.
Subject(s)
Aged, 80 and over , Female , Humans , Coronary Vessels , Fistula , Lung , Pulmonary EdemaABSTRACT
The purpose of this case report was to discuss the efficacy of The Amplatzer Vascular Plug (AVP) in endovascular aneurysm repair (EVAR) for ruptured aortoiliac aneurysm. A 73-year-old man was referred to our institution with a diagnosis of ruptured abdominal aortic aneurysm (rAAA) by CT scan. The CT scan showed an rAAA of 70 mm (Fitzgerald classification 3) and a right common iliac aneurysm of 30 mm. The patient was immediately transferred from the ER to the OR and treated with EVAR in combination with occlusion of the right internal iliac artery (IIA) using AVP. The total procedural time was 138 min. The patient recovered uneventfully after the operation with an ICU stay of 2 days and was discharged 9 days after the onset. EVAR has been recognized as a therapeutic option for rAAA in Japan. However, it is not yet been generally adopted as a first-line therapy for rAAA accompanied with iliac aneurysm because of the necessity to occlude IIA. The conventional method with coils to induce thrombosis of IIA is unsuitable for patients in a critical situation for the time required and the difficulty in precise placement. AVP is a nitinol-based self-expanding cylindrical device that is used for arterial embolization. AVP allows assured embolization of IIA in a shorter procedural time, which is essential in an urgent situation. Although AVP is still under post-market surveillance in Japan and only available in limited institutions, the usage of AVP should be considered as an adjunctive procedure in EVAR for rAAA and may expand the limits of endovascular treatment for rAAA.
ABSTRACT
El uso del Amplatzer® Vascular Plug (St. Jude Medical-Minnesota, EE. UU.) se ha diversificado y ha sido descrito con éxito en diferentes escenarios clínicos. Se describe otra aplicación para este dispositivo, presentando el caso de una paciente con antecedente de corrección de conexión anómala total de venas pulmonares a quien se le realizó oclusión de una vena vertical permeable con un Amplatzer® Vascular Plug.
The use of the Amplatzer® Vascular Plug has diversified and has been described successfully in different clinical settings. We describe another application for this device, presenting the case of a patient with a history of correction of total anomalous connection of pulmonary veins, who underwent occlusion of the unligated vertical vein with the Amplatzer® Vascular Plug.
Subject(s)
Child, Preschool , Female , Humans , Endovascular Procedures , Pulmonary Veins/abnormalities , Pulmonary Veins/surgery , Septal Occluder Device , Prosthesis DesignABSTRACT
El cierre percutáneo del conducto arterioso permeable (CAP) es una modalidad de tratamiento bien establecida. El Amplatzer vascular plug II (AVP II) es un dispositivo oclusor autoexpandible, indicado para oclusiones arteriales o venosas en la vasculatura periférica. Describimos nuestra experiencia clínica inicial en el cierre percutáneo del CAP, utilizando el AVP II en la edad pediátrica. El tamaño del dispositivo fue seleccionado de acuerdo al tamaño y morfología del CAP, con un diámetro mayor al 100% del diámetro mínimo del CAP. Los dispositivos fueron implantados a través de una vaina por vena o arteria femoral. En 18 pacientes, el AVP II se utilizó para oclusión del CAP. La mediana de edad fue 24 meses (intervalo: 6-51) y la media de peso, 10.5 kg (intervalo: 4.8-16.5). El diámetro más estrecho del CAP mostró una mediana de 1.1 mm (intervalo: 0.3-7.0). Se logró el implante exitoso y la oclusión angiográfica en 14 pacientes (77.8%). El tamaño del dispositivo implantado mostró una media de 3.9 ± 2.4 veces el diámetro mínimo del CAP. Dos pacientes fueron enviados a cirugía. Ocurrieron dos embolizaciones. El ecocardiograma transtorácico de 24 horas confirmó oclusión total en 13 casos (72.2%). Durante el periodo de seguimiento no se han reportado complicaciones. El cierre percutáneo de CAP < 2 mm con AVP II es una técnica segura y efectiva, particularmente para oclusión de vasos de pequeño diámetro con bajo flujo.
Percutaneous closure of patent ductus arteriosus (PDA) is a well established treatment modality. The Amplatzer vascular plug II (AVP II) is a self-expandable occluder device, indicated for arterial or venous occlusions in the peripheral vasculature. We describe our initial clinical experience in percutaneous closure of PDA using the AVP II in children. Device size was selected according to the size and morphology of the CAP, with a diameter greater than 100% of the minimum diameter of the CAP. The devices were implanted through a pod femoral vein or artery. In 18 patients, AVP II was used for occlusion of PDA. The median age was 24 months (range 6-51) and mean weight 10.5 kg (range 4.8-16.5). The narrowest diameter of the CAP showed a median of 1.1 mm (range 0.3-7.0). Successful implantation was achieved and angiographic occlusion in 14 patients (77.8%). The size of the implanted device showed a mean of 3.9 ± 2.4 times the minimum diameter of the CAP. Two patients were referred for surgery. There were two embolizations. Transthoracic echocardiography 24 hours confirmed total occlusion in 13 cases (72.2%). During the monitoring period there are no reported complications. Percutaneous closure of PDA < 2 mm AVP II is a safe and effective, particularly for occlusion of small-diameter vessels with low flow.
ABSTRACT
A pulmonary artery aneurysm is a common manifestation and the leading cause of mortality in Behcet's disease. We describe a case of spontaneous rupture of a pulmonary artery aneurysm that, due to the inadequacy of medical therapy and the disadvantages of surgery, became the ideal candidate for endovascular management and was successfully performed by using the Amplatzer Vascular Plug 4.
Subject(s)
Adult , Humans , Male , Aneurysm, Ruptured/diagnostic imaging , Behcet Syndrome/complications , Iopamidol/analogs & derivatives , Pulmonary Artery , Radiography, Thoracic , Septal Occluder Device , Tomography, X-Ray ComputedABSTRACT
Amplatzer vascular Plug II (AVP II) es un dispositivo oclusor autoexpandible, indicado para oclusiones arteriales o venosas en la vasculatura periférica. Objetivo: Describir nuestra experiencia clínica inicial con el AVP II, en el cierre percutáneo del conducto arterioso permeable pequeño. Métodos: Analizamos retrospectivamente, siete pacientes sometidos a oclusión percutánea del conducto arterioso. El AVP II se eligió con un diámetro mayor a 50% del diámetro mínimo del conducto arterioso. Resultados: Los pacientes evidenciaron un conducto arterioso con un diámetro mínimo de 1.5 ± 1.4 (intervalo: 0.8 a 4.7mm). Se logró un implante exitoso y con adecuada oclusión angiográfica en seis pacientes. Un paciente fue enviado a cirugía. Sólo observamos una complicación mayor. El ecocardiograma transtorácico a las 24 horas, confirmó la oclusión completa en estos pacientes. El seguimiento fue de 10.6 ± 9.1 meses. Conclusiones: El AVP II, en este grupo de pacientes mostró ser seguro y efectivo para el cierre percutáneo del conducto arterioso.
The Amplatzer vascular Plug II (AVP II) is a self-expanding occluder device, indicated for arterial and venous occlusion in the peripheral circulation. Objective: To describe our initial clinical experience with the AVP II, in the percutaneous closure of small patent ductus arteriosus. Method: We retrospectively analyzed seven patients who underwent percutaneous closure of patent ductus arteriosus. The AVP II was chosen with a diameter greater than 50% of the minimum diameter of the ductus arteriosus. Results:Patients showed a ductus arteriosus with a diameter of 1.5 ± 1.4 (range: 0.8 - 4.7mm). Successful implant was achieved with adequate angiographic occlusion in 6 patients. One patient was sent to surgery. We only found a major complication. Transthoracic echocardiography at 24 hours, confirmed the complete occlusion in this patients. The follow-up was 10.6 ± 9.1 months. Conclusion: The AVP II in this group of patients was shown to be safe and effective for percutaneous closure of patent ductus arteriosus.
Subject(s)
Child, Preschool , Female , Humans , Infant , Male , Ductus Arteriosus, Patent/surgery , Septal Occluder Device , Prosthesis Design , Retrospective StudiesABSTRACT
To report endovascular occlusion of an internal iliac artery aneurysm (IIAA) of two patients using Amplatzer vascular plug (AVP; AGA Medical Corporation, USA). A 69-year-old asymptomatic man had aneurysms of both internal iliac arteries. The size of the right (Rt) IIAA was 23 mm and that of the left (Lt) IIAA was 45 mm. We decided to induce vascular occlusion of the Lt internal iliac artery (IIA). We deployed an AVP in the proximal and distal Lt IIA. The patient was discharged after four days and showed no recurrence of aneurysm for one year. A 78-year-old women had lower abdominal pain for three days. Computed tomography scan showed a 43 mm Rt common iliac artery (CIA) aneurysm and a 38 mm Rt IIAA. We decided to insert a stent graft in the Rt CIA and to occlude the Rt IIA using AVP. We deployed the stent graft in the Rt CIA and the AVP in the distal Rt IIA. The patient was discharged after seven days and demonstrated no recurrence of aneurysm for four months. AVP is a feasible vascular occlusive device for internal iliac artery aneurysm.
Subject(s)
Aged , Female , Humans , Abdominal Pain , Aneurysm , Iliac Artery , Recurrence , Stents , TransplantsABSTRACT
We report the successful percutaneous closure of a large coronary fistula from the right coronary artery to the right ventricle in a 4-years-old boy using the Amplatzer vascular plug. The device was positioned and deployed via the arterial system.It allows a smaller delivery profile through small sheath or guide catheters and the technique appeared to be easy, safe, and effective.