Prevention of type II endoleak using the AMPLATZER vascular plug before endovascular aneurysm repair

Abstract

Objective: We evaluated the feasibility of visceral artery and lumbar artery (LA) embolization using AMPLATZER vascular plug (AVP) types 4 and 2 (AVP4, AVP2) prior to endovascular aneurysm repair (EVAR) to prevent the development of a type II endoleak.

Methods: Between January 2008 and April 2010, 45 arteries in 33 male patients were embolized with 44 AVP4 and one AVP2. Artery name and diameter; device number and size; and intervention, fluoroscopy, and deployment times for each procedure and each device were recorded. Computed tomography (CT) angiography was performed 2 days and 3, 6, 12, 18, 24, and 36 months after EVAR to confirm successful EVAR and embolotherapy, exclude endoleaks, and evaluate aneurysm shrinkage.

Results: AVP4 devices were implanted into the inferior mesenteric arteries in 33 cases, lumbar arteries in seven cases, and pelvic and renal arteries in two cases each. An AVP2 device was inserted into the gluteal artery in one case. The success rate was 100%, with total occlusion of all target vessels. No endoleaks were found in follow-up CT angiography.

Conclusion: The use of AVP prior to EVAR is an efficient embolization technique that prevents the development of type II endoleaks.

Keywords: AMPLATZER plug; Aortic aneurysm; EVAR; Endoleak; Prevention.