Feasibility and efficacy of percutaneous closure of paravalvuar leak in patients after heart valve replacement surgery using Amplatzer vascular plug Ⅲ / 中华心血管病杂志

Objective@#To investigate the feasibility and efficacy of percutaneous closure of paravalvuar leak (PVL) in patients after heart valve replacement surgery using Amplatzer vascular plug Ⅲ (AVP Ⅲ).@*Methods@#In this retrospective study, consecutive PVL patients after heart valve replacement surgery receiving percutaneous closure with AVP Ⅲ in Beijing Anzhen hospital between March 2017 and October 2018 (n=21) were enrolled.The preoperative and intraoperative data and short-and mid-term outcome results were analyzed.@*Results@#Theage of patients in this cohort was (54.9±11.7) years, and there were 12 (57.1%) male patients. There were 8 patients (38.1%) post mitral valve replacement, 4 patients (19.0%) post aortic valve replacement and 9 patients (42.9%) post double valves replacements.There were 14 cases (66.7%) of mitral valve PVL,6 cases (28.6%) of aortic valve PVL, and 1 case (4.8%) of double valves PVL.Successful device deployment was accomplished in 18 defects from 17 PVL patients. Technical successful rate of mitral valve PVL closure and aortic valve PVL closure was 12/15 and 6/7,respectively. One patient received surgical repair due to procedure-induced femoral pseudoaneurysm.There were 17 cases of severe PVL and 1 case of moderate PVL before procedure, and there were 2 cases of moderate PVL, 6 cases mild PVL, and PVL disappeared in 10 cases after procedure (P<0.01 vs. pre-procedure). The follow-up time was (8.3±4.7) months. There were 10 cases (58.8%) of New York Heart Association (NYHA) function grade Ⅲ and 7 cases (41.2%) of NYHA function grade Ⅳ before procedure, and there were 12 cases of NYHA function grade Ⅰ(70.6%) and 5 cases (29.4%) of NYHA function grade Ⅱ post procedure (P<0.01). Post procedure, there was no displacement of the occluder and heart valve movement was not affected,and there was no new hemolysis or hemolysis worsening.@*Conclusion@#Percutaneous closure of PVL in patients after heart valve replacement surgery with AVP Ⅲ is feasible, and associated with favorable short-and mid-term clinical outcomes.

Plug-Assisted Retrograde Transvenous Obliteration for the Treatment of Gastric Varices: The Role of Intra-Procedural Cone-Beam Computed Tomography

OBJECTIVE: To investigate the technical and clinical outcomes of plug-assisted retrograde transvenous obliteration (PARTO) for the treatment of gastric varices (GV) and to evaluate the role of intra-procedural cone-beam computed tomography (CBCT) performed during PARTO to confirm its technical success. MATERIALS AND METHODS: From January 2016 to December 2016, 17 patients with GV who had undergone PARTO were retrospectively evaluated. When the proximal part of the afferent vein was identified on a fluoroscopy, non-contrast CBCT images were obtained. In patients with incomplete embolization of GV, an additional injection of gelatin sponges was performed. Follow-up data from contrast-enhanced CT and upper intestinal endoscopy, as well as clinical and laboratory data were collected. RESULTS: Plug-assisted retrograde transvenous obliteration procedures were technically successful in all 17 patients. Complete embolization of GV was detected on CBCT images in 15 patients; whereas, incomplete embolization was detected in two. Complete embolization of GV was then achieved after an additional injection of gelatin sponges in these two patients as demonstrated on the 2nd CBCT image. The mean follow-up period after PARTO was 193 days (range, 73–383 days). A follow-up CT obtained 2–4 months after PARTO demonstrated marked shrinkage or complete obliteration of GV and portosystemic shunts in all 17 patients. There were no cases of variceal bleeding during the follow-up. CONCLUSION: Plug-assisted retrograde transvenous obliteration is technically and clinically effective for the treatment of GV. In addition, intra-procedural CBCT can be an adjunct tool to fluoroscopy, because it can provide an immediate and accurate evaluation of the technical success of PARTO.

Efficacy of the Plug Attachment Technique in a Patient Undergoing EVAR for Ruptured Abdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

<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>

Preliminary Experience with Vascular Plugs for Parent Artery Occlusion of the Carotid or Vertebral Arteries

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.

Plug-Assisted Retrograde Transvenous Obliteration for the Treatment of Gastric Variceal Hemorrhage

OBJECTIVE: To evaluate the feasibility, safety, and clinical outcomes of plug-assisted retrograde transvenous obliteration (PARTO) to treat gastric variceal hemorrhage in patients with portal hypertension. MATERIALS AND METHODS: From May 2012 to June 2014, 19 patients (11 men and 8 women, median age; 61, with history of gastric variceal hemorrhage; 17, active bleeding; 2) who underwent PARTO using a vascular plug and a gelfoam pledget were retrospectively analyzed. Clinical and laboratory data were examined to evaluate primary (technical and clinical success, complications) and secondary (worsening of esophageal varix [EV], change in liver function) end points. Median follow-up duration was 11 months, from 6.5 to 18 months. The Wilcoxon signed-rank test was used to compare laboratory data before and after the procedure. RESULTS: Technical success (complete occlusion of the efferent shunt and complete filling of gastric varix [GV] with a gelfoam slurry) was achieved in 18 of 19 (94.7%) patients. The embolic materials could not reach the GV in 1 patient who had endoscopic glue injection before our procedure. The clinical success rate (no recurrence of gastric variceal bleeding) was the same because the technically failed patient showed recurrent bleeding later. Acute complications included fever (n = 2), fever and hypotension (n = 2; one diagnosed adrenal insufficiency), and transient microscopic hematuria (n = 3). Ten patients underwent follow-up endoscopy; all exhibited GV improvement, except 2 without endoscopic change. Five patients exhibited aggravated EV, and 2 of them had a bleeding event. Laboratory findings were significantly improved after PARTO. CONCLUSION: PARTO is technically feasible, safe, and effective for gastric variceal hemorrhage in patients with portal hypertension.

Amplatzer® Vascular Plug III, para cierre de fuga paravalvular mitral residual: imagen de ecocardiograma transesofágico tridimensional / Amplatzer® Vascular Plug III, for closing residual mitral paravalvular leak: three-dimensional transesophageal echocardiography image

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).

Giant Hepatic Artery Aneurysm Associated with Immunoglobulin G4-Related Disease Successfully Treated Using a Liquid Embolic Agent

No abstract available.

Efficacy of the Amplatzer Vascular Plug in a Patient Undergoing EVAR for Ruptured Aortoiliac Aneurysm / 日本心臓血管外科学会雑誌

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.

Coronary Artery Fistula Draining into Lung Parenchyma Causing Localized Pulmonary Edema: Transcatheter Closure with an Amplatzer Vascular Plug 4

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.

Cierre percutáneo del conducto arterioso permeable en niños utilizando el Amplatzer vascular plug II / Percutaneous closure of patent ductus arteriosus in infants using the Amplatzer vascular plug II

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.

Oclusión percutánea de la vena vertical con un Amplatzer® Vascular Plug: Informe de un caso / Endovascular occlusion of the vertical vein with an Amplatzer® Vascular Plug: Case report

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.

Use of Amplatzer Vascular Plug to Treat a Biliary Cutaneous Fistula

Several substances have been used in an attempt to sclerose biliary ducts associated with persistent biliary-cutaneous fistula (BCF). The AMPLATZER Vascular Plug (AVP; AGA Medical, USA) system is a recently developed endovascular occlusion device, introduced as an alternative to permanent embolic materials (metallic coils or acrylic glue), in the occlusion of large and medium-calibre arteries and veins. We report a successful use of the AVP to embolize BCF, developed after the removal of an internal-external biliary drainage.

Endovascular Treatment of a Ruptured Pulmonary Artery Aneurysm in a Patient with Behcet's Disease Using the Amplatzer Vascular Plug 4

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.

Transcatheter Treatment of Patent Foramen Ovale Combined with Abnormal Drainage of Left Superior Vena Cava to Left Upper Pulmonary Vein

Patent foramen ovale (PFO) has been known to be the cause of transient ischemic attacks or stroke, and transcatheter device closure has been the treatment of choice for these defects. Combined defect of abnormal drainage of left superior vena cava (LSVC) to left superior pulmonary vein (LSPV) in PFO patients is an uncommon combination, and both can act as a pathway for paradoxical embolism. We report a successful closure of PFO, using Amplatzer(R) PFO occluder (St. Jude Medical, St. Paul, MN, USA) and persistent LSVC connected to LSPV using an Amplatzer(R) Vascular Plug II (St. Jude Medical, St. Paul, MN, USA). Because this combined anomaly of PFO and persistent LSVC can be treated by a single transcatheter intervention, if clinically suspected, a complete evaluation for this anomaly should be considered.

Cierre percutáneo del conducto arterioso permeable utilizando el Amplatzer vascular Plug II / Percutaneous closure of patent ductus arteriosus using the Amplatzer vascular Plug II

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.

Endovascular Treatment of an Internal Iliac Artery Aneurysm Using Amplatzer Vascular Plug: 2 Case Reports / 대한혈관외과학회지

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.

Embolotherapy for Pulmonary Arteriovenous Malformations in Patients without Hereditary Hemorrhagic Telangiectasia

OBJECTIVE: To evaluate the clinical and radiological outcomes of transcatheter embolotherapy for treating sporadic pulmonary arteriovenous malformations (PAVMs) that were not associated with hereditary hemorrhagic telangiectasia. MATERIALS AND METHODS: Between January 2001 and June 2008, thirty-five sporadic PAVMs were detected in 23 patients. The clinical follow up consisted of assessing the changes of the signs and symptoms of the PAVMs, and radiological evaluation with chest radiographs or chest CT scans. RESULTS: The lower lung regions (63%) and peripheral locations (86%) were the common locations of the PAVMs. Thirty-four PAVMs (97%) had simple architecture (one arterial feeder within a single pulmonary segment). Technical success was achieved in 33 PAVMs (94%); two cases of technical failure were due to catheterization failure (n = 1) and too large a feeding artery (17 mm) that disabled embolotherapy (n = 1). Coils and Amplatz vascular plugs were used in 30 and three PAVMs, respectively. Inadvertent placement of one coil (n = 1) and pulmonary infarction (n = 1) occurred, but no relevant symptoms developed. For the 13 patients with available data, the mean arterial O2 saturation changed significantly from 92% to 98%. Complete or near-complete involution of the sac was observed in 30 of the 33 embolized PAVMs (91%). In these 33 embolized PAVMs, the mean sac diameter significantly decreased from 17.83 mm to 0.68 mm. CONCLUSION: Sporadic PAVMs are mostly the simple type with predominance in the lower lobe and peripheral locations. Transcatheter embolotherapy with coils or Amplatz vascular plugs is a safe and effective treatment for sporadic PAVMs and this provides excellent functional and radiological improvement.

Transcatheter Closure of a Large Coronary Arteriovenous Fistula Using an Amplatzer Vascular Plug

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.