Embolization of Vessels With Irregular Lumen Using the Coil Packing Technique Between the Amplatzer Vascular Plug II Lobes

TL;DR

This paper introduces a technique to improve embolization in arteries with irregular shapes using coils between vascular plug lobes.

Contribution

A novel coil packing technique is proposed to enhance embolization in vessels with irregular lumens using AVP II.

Findings

Leakage was significantly higher in models with stenotic lesions compared to smooth ones.

The coil packing technique was successfully applied in 11 clinical cases without complications.

Follow-up imaging showed no recanalization or leakage after the procedure.

Abstract

Introduction: The Amplatzer Vascular Plug (AVP) series enables precise positioning and high migration resistance, allowing embolization in short segments; however, inadequate embolization or recanalization may occasionally occur. We hypothesized that leaks may occur when AVPs are implanted in vessels with irregular lumen due to insufficient adherence to the vessel. This hypothesis was tested by experiments with a vascular model. We employed a coil packing technique between the AVP lobes to embolize internal iliac arteries with an irregular lumen.

Methods: Saline was injected through the Y-shaped glass tubes of the stenotic and the smooth model (without stenotic lesion), and the amount of leakage was measured when the AVP was deployed. The feasibility and effectiveness of filling coils between the lobes of AVP II were evaluated. A total of 11 cases were retrospectively reviewed using this technique for internal iliac artery embolization prior to endovascular aortic repair.

Results: The amount of leakage was significantly higher in the presence of stenotic lesions. Insertion of a 2.2 F microcatheter from the side of the proximal lobe of AVP II and filling of coils was achieved in all 11 cases. Follow-up contrast-enhanced CT showed no recanalization, leakage, or other obvious complications.

Conclusion: Coil packing technique around Amplatzer Vascular Plugs could be an effective method and a reliable option for arterial embolization, especially in vessels with irregular lumens.

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