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Clinical Experience with Amplatzer ® Vascular Plugs Background: The Amplatzer ® vascular plugs I and II (AVPsI and II) are low profile self-expandable devices made ofnitinol, designed for vascular occlusions. We report ourexperience with these devices in two tertiary referralhospitals. Method: Retrospective study of patients undergoingvascular occlusion procedures with AVPs since 2005. Thedevices were 30%-50% larger than the target vessel, deployedunder general anesthesia via femoral and internal jugularvein or femoral and brachial artery, and delivered throughguiding catheters or 5 F to 8 F long sheaths. Results: Four-teen patients (50% male) at a median age of 5 years (11months to 70 years) and a median weight of 15 kg (8 kgto 67 kg) were identified. Seventeen AVPs were used: 2AVPs II and 15 AVPs I, with a diameter ranging from 4 mmto 16 mm. In 3 patients with more than one vessel toocclude, 2 AVPs were implanted in each vessel. In 3 patientswith coronary fistula total occlusion of the vessels occurredafter 24 hours. In 2 patients with modified Blalock-Taussigshunts, there was total occlusion of the anastomosis, withthe use of additional coils in one. In 3 patients with veno-venous fistulas after Glenn or Fontan operations, therewas complete occlusion of the vessels and improved sa-turation, with the use of additional coils in one. Anotherpatient with venovenous fistula had mild residual shunt inthe lab and total occlusion observed at echocardiographicmonitoring within 24 hours. Two patients with multiplepulmonary arteriovenous malformations underwent closureusing the AVP, other Amplatzer devices and Gianturco’scoils, with minimal residual shunts in all cases. In 2 patientswith systemic-pulmonary collaterals in the postoperativeperiod of pulmonary atresia and VSD repair, there wascomplete occlusion with the aid of additional coils, oneimmediately after the procedure and the other within 24hours. In one patient with scimitar syndrome the systemiccollateral vessel was totally occluded. There was noembolization or death. |
