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Vascular plugs have been increasingly used because they have lower recanalization rates than coil embolization in pulmonary arteriovenous malformation (PAVM) embolization. To deliver the vascular plug close to the PAVM, a large-diameter catheter should be advanced into the feeding pulmonary artery, which carries a risk of vascular damage. Fifty-three-year-old women was admitted to our hospital for embolization of a single PAVM. Pulmonary angiography revealed a simple PAVM with a tortuous, small feeding artery in the right middle lobe, and feeding artery negotiation was attempted using a 5-Fr headhunter-type catheter to deliver the vascular plug. However, unintentional arterial perforation occurred suddenly when the guide wire was withdrawn after the catheter was advanced to the feeding artery adjacent to the sac. Immediate embolization using a vascular plug and microcoils at the proximal site of the perforation was performed to stop both PAVM shunt flow and bleeding. To prevent such a catheter-induced complication, it is necessary to select a diagnostic catheter with appropriate stiffness and angle and to switch to a small-diameter delivery system depending on the situation.

A five-month-old, intact female domestic shorthair cat was presented to a specialty referral hospital for evaluation of a patent ductus arteriosus. Transvenous embolization of the defect was achieved with a commercially available peripheral vascular plug. The use of vascular plugs for the closure of patent ductus arteriosus has been validated in dogs, yet literature for its use in cats is lacking. The product and procedural details of the device are described.

A case of a severe paravalvular mechanical mitral prosthesis leak (PVL) in a high-risk surgical patient, complicated with acute heart failure at presentation is described. Considering the high surgical risk and the specific echocardiographic features that would prevent the interventional cardiologist to have a direct access to the PVL with a traditional vascular plug or duct occluder, a percutaneous PVL closure with an Amplatzer-Amulet (Abbott, Abbott Park, Illinois, United States) LAA device (28 mm) was chosen for the contiguity of the PVL to the left atrial appendage (LAA). A new-onset hemolysis post-PVL closure and severe renal failure requiring hemodialysis occurred after the procedure, treated with surgical device removal and leak suture. To the best of our knowledge, this is the first case that describes the attempt to close a PVL, contiguous to the LAA, using the Amulet device. The attempt to close a PVL with these features with an Amplatzer-Amulet device, although promising, does not appear completely safe to reach the goal, as in our case. In our opinion, the most important reasons are that specific technical recommendations and broad experiences are lacking. Indeed, specific outcomes of this kind of approach are, to date, still unknown.

The condition of partial anomalous origin of a branch pulmonary artery from the descending aorta could be found in several diseases and should be carefully differentiated. We report an unusual case of anomalous systemic arterial supply to normal basal segments of the left lower lung and another case of intralobar pulmonary sequestration. These two cases were treated successfully by transarterial embolisation using the Amplatzer Vascular Plug. We also set up a diagnostic algorithm to differentiate these diseases from anomalous systemic arterial supply to the pulmonary region. It is possible to make the correct diagnosis using the step-by-step diagnostic algorithm and careful interpretation of chest computed tomography angiography.

Introduction The family of Amplatzer Vascular Plugs (AVPs) is characterized by their precise deployment and high resistance to migration. However, a risk of recanalization of the embolized vessels has been reported. To augment the effectiveness of embolization, the coil-in-plug (CIP) technique was developed, exclusively using AVP I or IV. However, these plugs cannot be used for large vessels like portovenous shunt because of the size limitation. AVP II has a larger-sized model up to 22 mm. This article reports two cases of embolizing high-flow and large-caliber portosystemic shunts where the CIP technique with multilayer AVP II was effectively employed. Materials and methods The CIP technique using AVP II was utilized for one case with a portocaval shunt and another with a splenorenal shunt. CIP was established with wire penetration through the multilayer meshes, followed by a microcatheter insertion. After the microcatheter was positioned in the central lobe, the internal space was embolized tightly using pushable or detachable coils. Results A use of guidewire with a high tip load enabled an establishment of CIP and complete occlusion of the target vessels immediately without migration of the embolic devices in both cases. The symptom of encephalopathy improved after the procedure in both the case of the portocaval and the splenorenal shunt. Conclusion The CIP technique with the AVP II was safe and effective to achieve complete occlusion of the large-caliber portosystemic shunts.

Objectives Determine if the Amplatz™ Vascular Plug 4 (AVP4) can be used to occlude left-to-right shunting patent ductus arteriosus (PDA) in dogs with inadequate arterial vascular access for the Amplatz Canine Duct Occluder (ACDO). Animals Six adolescent dogs with PDA whose femoral artery was too small for insertion of a 4 Fr vascular access sheath. Materials and methods Standard femoral arterial vascular access and a 4 Fr diagnostic catheter were used to deploy an appropriately sized AVP4 into the PDA of each dog. Successful occlusion was defined as no residual ductal flow and determined by color Doppler echocardiography and angiography. Results The AVP4 was successfully deployed, and complete occlusion of the PDA was achieved in all dogs. There were no complications encountered in any of the dogs. Conclusions The AVP4 is a viable option for the correction of PDA in dogs with inadequate arterial vascular access for the ACDO and should be considered as one of the options available for PDA correction in this challenging animal population.

Background Pulmonary artery-to-left atrial fistula is a variant of pulmonary arteriovenous fistula and is a developmental anomaly. Delayed presentation, cyanosis and effort intolerance are some of the important features. The diagnosis is confirmed by computed tomography or pulmonary artery angiography. Catheter-based closure is preferred to surgery. Case summary Left pulmonary artery-to-left atrial fistula is rare. A 40-year-old male presented with effort intolerance, central cyanosis, and recurrent seizures. He had a large and highly tortuous left pulmonary artery-to-left atrial fistula associated with a large aneurysmal sac in the course. Catheter-based closure was performed using a vascular plug. Conclusion Left pulmonary artery-to-left atrial fistula is relatively uncommon compared to right pulmonary artery-to-left atrial fistula. Percutaneous closure by either a transeptal technique or guide wire insertion into the pulmonary vein through the pulmonary artery is preferred. The need for an arteriovenous loop depends on the tortuosity of the course of the fistula and the size of the device to be implanted because a larger device needs a larger sheath, necessitating firm guide wire support to facilitate negotiation of the stiff combination of the delivery sheath and dilator.

The levoatriocardinal vein is a rare vascular anomalous connection between the left atrium and the superior vena cava (or left innominate vein). This defect is usually associated with left heart obstructive lesions, while it is rarely found in an isolated form. In the former case, the anomalous connection causes a pre-tricuspid left-to-right shunt with right-heart volume overload. We describe the first case of “double” homolateral levoatriocardinal vein in a child with signs and symptoms of right-heart failure and pulmonary blood-flow overload. A trans-catheter closure of both vascular connections was performed with two Amplatzer Vascular Plug type II (Abbott, Plymouth, MN, USA). The percutaneous approach proved to be safe and effective, with early improvement in the signs and symptoms of heart failure.

Coronary arteriovenous fistulas are rare anomalies that connect one or more coronary arteries to a cardiac chamber or other vascular structure. These communications can be occluded using percutaneous treatment, and there are currently several approaches and techniques. We report the case of an adolescent aged 12 years and 10 months, with a large fistula of the right coronary artery draining into the right ventricular cavity, in which the Amplatzer® Vascular Plug II device was used. The technical steps used are described in detail, with excellent immediate results.

Background This case series describes the use of the Medtronic Micro Vascular Plug (MVP) system in the treatment of acute massive orofacial hemorrhages in patients with cancer and trauma, resulting in successful hemostasis in these emergent cases. Case Description The first case describes a patient who presented with life-threatening oropharyngeal hemorrhage after a motor vehicle accident. In the second case, a patient with oropharyngeal cancer presented with life-threatening bleeding from an ulcerated tumor. Patients were successfully treated with a combination of MVP and coils. Immediate postprocedural imaging confirmed that homeostasis was achieved. Conclusions These cases demonstrate that the MVP as an embolic device is a valuable transarterial embolic treatment option in cases of acute orofacial bleeding where rapid, effective hemostasis is required.

Background Transcatheter closure of patent ductus arteriosus (PDA) is an effective alternative to surgical ligation in preterm infants. However, data on device deformation and risk of left pulmonary artery (LPA) obstruction remain scant. This study describes the outcomes and complications of transcatheter closure of PDA in preterm infants weighing Methods Amplatzer Piccolo Occluder and Amplatzer Vascular Plug were used. Echocardiography was repeated at prespecified intervals. The device waist and length were assessed through lateral fluoroscopy immediately and at least 3 months after deployment. Results Fourteen infants were prospectively enrolled (mean procedural weight 1335 g, procedural age 24 days), and all procedures were successful. There was no obstruction of adjacent vessels immediately after deployment. At follow-up, three infants developed aortic coarctation, all of which resolved gradually. Obstruction of the LPA occurred in eight infants, with five being severe cases. Compared with the shape immediately after deployment, the devices became significantly more flattened and lengthened at follow-up in patients with LPA obstruction. This deformation was nonsignificant in infants without any LPA obstruction. The ratio of the device waist after deployment to the nominal waist ( Conclusions Device deformation occurring late at follow-up is common and may be associated with LPA obstruction in preterm infants after transcatheter PDA closure. Meticulous device selection and implantation technique are crucial for minimizing the associated risks.

Balloon- or plug-assisted retrograde transvenous obliteration of portosystemic shunts is an effective endovascular technique for the treatment of type B bypass hepatic encephalopathy. We describe a patient who underwent balloon- and plug-assisted obliteration for a lienorenal and lienogonadal shunt, respectively. He returned with symptoms of recurrent hepatic encephalopathy two years later due to reformation of new lienorenal and lienogonadal shunts. Repeat obliteration of these new shunts was now performed using balloon and coil assistance. We describe the treatment for multiple portosystemic shunts with combined usage of vascular plug, balloon and coils depending on anatomical and technically factors. Our case also highlights that after shunt obliteration increased portal pressure may form new portosystemic collateral pathways which leads to clinical failure and may require repeat treatment.

A 32-year-old woman presented with moderate effort intolerance, hemoptysis and cyanosis.She was found to have pulmonary arteriovenous malformations (PAVM) in the right lower lobe along with severe rheumatic calcific mitral stenosis. She underwent hybrid intervention, initially transcatheter fistula closure with CERA 24 mm Vascular Plug followed by mitral valve replacement. Her saturation normalized following intervention. She remained well in short term follow up.

Summary We are reporting a case of a 34-year-old patient with history of surgical repair of aortic coarctation at the age of 7 and hybrid repair at the age of 32. He is presented with chest pain and the CT scan showed an endoleak with restoring of aortic pseudoaneurysm by a 9 mm abnormal vessel. We performed embolization of this channel by deploying an Amplatzer vascular plug. The angiographic result was satisfactory and patient became asymptomatic. Six months later, CT scan showed no increase in pseudoaneurysm diameter. Amplatzer Vascular Plug can be safely used in the treatment of recurrent aortic coarctation.

Objective:To evaluate the feasibility, efficacy, and safety of Amplatzer vascular plug II in large and elongated ducts in infants.Introduction:Patent arterial duct device closure is technically challenging in infants with large and elongated ducts because Amplatzer duct occluder and Amplatzer duct occluder II have high chances of causing aortic coarctation and left pulmonary artery stenosis, respectively. The Amplatzer vascular plug II being soft with no retention discs on either sides helps in mitigating these problems.Method:This is a prospective, observational study involving infants with clinical, echocardiographic and angiographic evidence of large left to right shunt. All the children underwent duct closure using Amplatzer vascular plug II.Results:Eighteen infants qualified for the study. Mean age and weight were 8.63 ± 3.84 months and 6.3 ± 1.7 kg, respectively. The angiographic mean duct diameter at the pulmonary artery end was 4.66 ± 0.92 mm, and the mean duct length was 9.4 ± 2.48 mm. The size of Amplatzer vascular plug II used varied from 6 mm to 10 mm. Technical success was achieved in 16/18 cases. One patient had device embolisation, and in the other, the device was found to be unstable. The ratio of Amplatzer vascular plug II size to the duct diameter was 1.65 ± 0.27, while the ratio of ductal length to device length was 1.48 ± 0.46 in those with successful outcome.Conclusions:Amplatzer vascular plug II is a safe and effective option in appropriately selected infants with elongated ducts. Diameter and length of Amplatzer vascular plug II vis-a-vis those of the ductus are important determinants of the successful outcome.

Gerbode defect is defined as an abnormal left ventricle–right atrium shunting which may have congenital or acquired origin, first described by Thurman in 1838, representing 0.08% of intracardiac shunts and

Single-leaflet detachment of the MitraClip is a mechanism of early failure, but management is challenging and often requires surgical repair. This case report describes a novel transcatheter approach to repairing severe mitral regurgitation after MitraClip single-leaflet detachment by placement of an additional clip and an Amplatzer vascular plug. (Level of Difficulty: Advanced.), Graphical abstract, Single-leaflet detachment of the MitraClip is a mechanism of early failure, but management is challenging and often requires surgical repair. This…

Introduction Renal arteriovenous fistula (AVF) is not considered a common condition; however, it can occasionally complicate with renal impairment and heart failure secondary to high cardiac output. Recently, percutaneous embolization has overcome traditional surgery as the first line of its management, because of better success rates as well as less morbidity and mortality. Case report A 68-year-old male who presented with a renal AVF post left partial nephrectomy associated with a large pseudoaneurysm. This was found on a computed tomography angiography (CTA) scan, a routine follows up for his endovascular aortic aneurysm repair. Due to the patient’s co-morbidities and to avoid the potentially fatal pseudoaneurysm rupture, a minimal invasive approach was agreed in the multidisciplinary meeting. He was treated by percutaneous transcatheter embolization using the Amplatzer Vascular Plug II (AVP-II) through a right femoral arterial access. The patient recovery was uneventful, following an overnight stay he was discharged home. CTA done four and ten months later showed the AVP-II device inside the left renal artery branch feeder with no artifacts seen. There was absence of recanalization of the AVF. In the literature, adopting the transarterial route for the renal AVF treatment with AVP-II device as a single embolotherapy device has not been reported before. Conclusions Our report display the feasibleness of AVP-II in renal AVF treatment by arterial feeder embolization, specifically in fistulas with high flow and short communication as our case in which it showed offered multiple advantages over coils and is more cost effective.

Aim To describe a 3 years experience of peripheral arterial embolization with Micro Vascular Plug (MVP) (Medtronic, USA). Materials and methods The following parameters were investigated: type of vascular injury, anticoagulation therapy at time of procedure, anatomical district, caliper of the target artery, course of the landing zone, additional embolics, technical and clinical success, device related clinical complications. Technical success was defined as complete embolization without deployment of additional embolics after MVP release. Primary clinical success was considered as hemodynamic stability in emergency setting and resolution of the underlying vascular pathology in elective cases; secondary clinical success was considered clinical success after a second embolization session. Results 116 MVP have been released in 104 patients (67 males and 37 females; mean age 61.3 years). The pullback release technique was adopted in each case. 85 patients were treated in emergent settings while in 19 patients the procedure was scheduled. The overall technical success was 75%. Primary clinical success was 96.1%, secondary clinical success 3% and clinical failure 0.9%. No statistical differences in terms of effectiveness were observed among patients assuming anticoagulation (p-value = 0.6). A straight and longer landing zone were statistically associated with higher technical success compared to curved and shorter ones, (p-values Conclusion MVP is a safe and effective embolic agent. While eventual concomitant anticoagulation therapy did not influence the technical outcome, straight course and length of the landing zone are essential parameters to evaluate before deployment.

Pseudoaneurysms are a rare complication of cardiovascular surgery, caused by disruption of the aortic structure (adventitia, media, and intima). Some reports have observed an extremely high mortality rate associated with the open surgical repair of pseudoaneurysms. In elderly or highly frail patients, the use of less invasive procedures is preferable. In this article, we report a case of an octogenarian who had a symptomatic ascending aortic pseudoaneurysm and a history of two sternotomies and present the successful treatment strategy. We treated the patient via an endovascular procedure using an Amplatzer Vascular Plug II (AVP II). After the intervention, the symptoms of the patient resolved. A computed tomography scan performed 1 year after the procedure confirmed the exclusion of the pseudoaneurysm.

OBJECTIVES To describe a novel technique for mechanical thrombectomy (MT) in young children. BACKGROUND Acute thrombosis in children may be a cause of significant morbidity or mortality. MT options in children are limited due to patient and vessel size, prompting consideration of innovative approaches. METHODS Two-center review of children with symptomatic non-cerebral thrombotic vessel occlusion. A novel approach to MT was performed using a deployed but unreleased amplatzer vascular plug (AVP) to "scrape" the target vessel in retrograde fashion, thereby harvesting the thrombus via the access sheath. RESULTS AVP-MT was performed in four patients at a median age of 2 months (range: 1 day-11 months) and median weight of 5.6 kg (1.8-10.9). In two cases, AVP-MT was performed in isolation in neonates on cervical extracorporeal membrane oxygenation (ECMO) support with cannula-associated obstructive aortic and brachiocephalic thrombus. AVP-MT was also performed as adjunctive therapy in a patient with single ventricle physiology and pulmonary artery thrombosis and in an infant with mitral valve endocarditis and femoral arterial thromboembolism. In all cases, AVP-MT was used to successfully remove thrombus from the target vessel and restore arterial flow, without procedural complications. Recurrent thrombosis occurred in both neonates, due to persistence of the ECMO cannula, with subsequent mortality. The other children were free of recurrent thrombus at 2 and 34 months. CONCLUSIONS Acute relief of symptomatic thrombosis may be achieved using AVP-MT in small children, although thrombosis frequently recurs, and clinical prognosis may remain poor. This strategy should be considered when alternative MT treatment options are not applicable.

Purpose To assess the efficacy and safety of the AMPLATZER Vascular Plug type IV for pulmonary arteriovenous malformation (PAVM) treatment. Materials and Methods Between June 2013 and January 2018, 13 patients with 26 PAVMs were treated with the type IV AVP. Patients without follow-up computed tomography (CT) were excluded. Technical success was defined as flow occlusion on angiography. Plug-to-sac distance was measured on angiographic images. Feeding artery and venous sac diameter changes were measured on preprocedural and follow-up CT. Successful embolization was defined as > 70% sac size regression. Procedure time, device migration, and complications were evaluated. Results Nine female patients (mean age, 49 y; range, 40–71 y) with 19 PAVMs were enrolled. Four patients with 7 PAVMs were lost to follow-up. Nineteen PAVMs were treated in 11 sessions, and the mean procedure time was 29 min. The technical success rate was 100%. Mean feeding artery diameter was 3.1 mm ± 0.7 (range, 2.1–4.9 mm). Mean plug-to-sac distance was 5.4 mm ± 4.9 (range, 0–13.3 mm). The mean CT follow-up period was 14 months ± 7 (range, 6–30 mo). Sixteen of 19 PAVMs (84%) were successfully embolized. Minor complications (tachycardia and chest discomfort) arose in 2 of 11 sessions. No device migrations or major complications occurred. Conclusions The type IV AVP showed an 84% treatment success rate based on 70% sac size regression criteria in small PAVMs. There were no device migrations or major complications.

Purpose To evaluate effectiveness of the polytetrafluoroethylene-covered nitinol mesh microvascular plug (MVP) and compare it with other devices in pulmonary arteriovenous malformation (PAVM) embolization in patients with hereditary hemorrhagic telangiectasia (HHT). Materials and Methods Twenty-five patients (average age 35 y; range, 15–56 y) with hereditary hemorrhagic telangiectasia (HHT) and de novo PAVM embolization with at least 1 MVP between November 2015 and May 2017 were retrospectively evaluated. Retrospective data were also obtained from prior embolization procedures in the same patient population with other embolic devices dating back to 2008. Technical success, complications, PAVM persistence rates, and category of persistence were analyzed. Results In 25 patients, 157 PAVMs were treated: 92 with MVP, 35 with AMPLATZER vascular plug (AVP), 6 with AVP plus coils, and 24 with coils. The per-PAVM technical success rates were 100% with MVP; 97%, AVP; 100%, AVP plus coils; and 100%, coils. PAVM persistence rates and median follow-up were as follows: MVP, 2% (1/92) (510 d); AVP, 15% (3/20) (1,447 d); AVP plus coils, 20% (1/5) (1,141 d); coils, 46.7% (7/15) (1,141 d). Persistence owing to recanalization for MVP, AVP, AVP plus coils, and coils was 2%, 15%, 0%, and 33%. No difference was found between persistence rates of MVP vs AVP (P = .098). Embolization with a vascular plug (MVP or AVP) with or without coils had a statistically significant lower persistence rate (5.4%) than embolization with coils alone (46.7%) (P = .022). Conclusions PAVM embolization with MVP had a high technical success rate and a low persistence rate comparable to AVP and lower than coil embolization alone.

The Amplatzer Vascular Plug Type II™ (AVPII) has been considered and used for the percutaneous closure of certain cases of persistent patent ductus arteriosus. Certain institutions use this device preferentially over the Amplatzer Duct Occluder Type I (ADOI). We present a series of three cases that highlight the versatility and applicability of this device, particularly in cases of adult congenital heart disease. This device is particularly useful when ductal anatomy cannot be precisely elucidated, or in adults with abnormal or difficult to define ductal anatomy. Two of the three cases presented were percutaneous interventions that were performed in Leon, Nicaragua, highlighting the use of the AVPII in resource-limited settings where device adaptability and cost are paramount.

[Background] Left subclavian artery (LSA) embolization is occasionally required to prevent type II endoleak in the thoracic endovascular aortic repair (TEVAR) procedure. This is a retrospective study comparing compressed Amplatzer Vascular Plug II embolization (CAE) and conventional coil embolization (CCE) in preventing retrograde flow into the aneurysmal sac through the LSA after TEVAR. [Methods] We retrospectively reviewed the records of patients who underwent CAE or CCE of the LSA during TEVAR from June 2013 to March 2016 in our hospital. The efficacy, safety and cost of each method were compared between two groups. [Results] Thirty patients underwent LSA embolization during TEVAR. Six CCEs in 6 patients were performed from June 2013 to November 2013, while twenty-four CAEs in 24 patients were performed from December 2013 to March 2016. Technical success was achieved in all patients in both groups. No embolization-related complications or type II endoleaks from LSA were recorded during the follow-up period in all patients. In both groups, all embolic materials were detected in the proximal portion of the LSA from the LSA orifice to the vertebral artery origin and no vertebral artery occlusions were detected. The mean compression ratio of AVP II was 58 ± 5.9% of predicted length of standard procedure. In the CAE group, one AVP II was sufficient to achieve complete LSA occlusion in all patients. On the other hand, multiple coils (10.2 ± 2.7) were used in the CCE group (P < .01), resulting in a significantly lower cost incurred in the CAE group (CAE: 129,000 JPY vs. CCE: 639,600 ± 140,060 JPY; P < .01). [Conclusion] The CAE is a useful and cost-effective procedure for TEVAR-related LSA embolization.

Background: The purpose of this study was to evaluate and compare the clinical effectiveness and costs of using the Caterpillar Arterial Embolization Device (Caterpillar) and fibered coils in arterial embolization cases. Methods: In this multicenter retrospective study, demographic, laboratory, and procedural data were collected on a total of 48 patients between February 2020 and September 2020. Data were collected on 16 Caterpillar placements and matched with 32 controls who underwent coil embolization of the same vessel with a similar size. Clinical and procedural outcomes including type and size of vessels, time to vessel occlusion, fluoroscopy time, total procedure time, and costs were analyzed and compared. Results: Relative time to occlusion was significantly decreased in the Caterpillar group compared to the controls (57 ± 34 s vs. 11 min 44 s ± 8 min 13 s, p = 0.00001611). Fluoroscopy time (6.9 ± 15 min vs. 19.2 ± 14, p = 0.017) and total procedure time (81.0 ± 36 min vs. 111.5 ± 49 min, p = 0.015) were significantly reduced compared to the coil group. Lastly, overall cost of embolic materials was 1050 ± 0 USD for the Caterpillar group compared to 2312.75 ± 1382.84 USD in the coil group (p = 0.000532). Conclusion: The Caterpillar embolic devices appear safe and effective in arterial occlusion. Compared to fibered coils, the Caterpillar device results in decreased time to vessel occlusion, decreased fluoroscopy and procedural time, and decreased costs, making the Caterpillar an appealing choice for arterial embolization.

To describe our institutional experience with MVP™ micro vascular plug systems for the treatment of pulmonary arteriovenous malformations (PAVMs). We performed a retrospective medical record review of 52 patients with 119 PAVMs treated exclusively with MVP™ systems (69 procedures/153 MVP™ systems) between July 2014 and July 2018. All patients had PAVMs with feeding artery diameters ≥ 2 mm. MVP™ systems were deployed according to physician preference. We collected patient demographic information; procedural data (including size of feeding artery, size and number of embolics used per PAVM, fluoroscopy time, contrast administration), technical success rates, complications, and persistence. Persistence was assessed using computed tomography angiography (CTA) performed 1–3 months and 3–5 years after embolization per clinical protocol. All procedures were technically successful without major complications. Mean feeding artery diameter was 3.3 ± 1.2 mm. Mean fluoroscopy time per procedure and contrast volume administered per procedure were 35 ± 16 min and 217 ± 101 mL, respectively. A mean of 1.3 ± 0.8 MVP™ systems was used per PAVM. There were no instances of persistence during a mean follow-up time of 328 ± 258 days (range 26 to 914 days). For PAVMs with feeding artery diameters of 2 to 7.9 mm (mean 3.3 ± 1.2 mm), MVP™ systems are safe and effective given their high technical success rates and lack of persistence. Further prospective work will be required to elucidate the advantages and disadvantages of these MVP™ systems for PAVM embolization. Level III.

Aim: To describe a three years experience of peripheral arterial embolization with Micro Vascular Plug (MVP) (Medtronic, USA).Materials and methods: 116 MVP have been released in 104 patients (67 males and 37 females; mean age 61.3 years). The pullback release technique was adopted in each case. The following parameters were investigated: angiographic appearance of the vascular injury, anticoagulation therapy at time of procedure, district, caliper of the target artery, course of the landing zone, additional embolics, technical and clinical success.Technical success was defined as complete embolization without deployment of additional embolics.Primary clinical success was considered as hemodynamic stability in emergency setting and resolution of the underlying vascular pathology in elective cases; secondary clinical success was considered clinical success after a second embolization session.Results: Vessel occlusion was achieved in 78 patients after MVP release, while in 26 subjects additional embolics were required; the overall technical success was 75%. Primary clinical success was 96.1%.MVP was oversized between 30% and 40% compared to the target vessel caliper; MVP-3 and MVP-5 were the most frequently adopted in this sampleNo statistical differences in terms of effectiveness were observed among patients assuming anticoagulation. A straight and longer landing zone were statistically associated with higher technical success compared to a curved and a shorter ones, respectively. No clinically adverse events directly related to MVP device occurred; in 3 cases migration was registered without clinical complications.Conclusion: MVP is a safe and effective embolic device. Oversizing is recommended. While eventual concomitant anticoagulation therapy did not influence the technical outcome, straight course and length of the landing zone are essential parameters to evaluate before deployment.

Background Ovarian vein embolization in pelvic varicocele is usually obtained using nitinol coils. These devices can not be used in patients with proven nickel allergy. Case presentation Shape memory polymer is a new embolic material available to interventionalists. A patient presented with pelvic congestion syndrome requiring embolisation of the left ovarian vein. The target vessel consisted of two twisted branches, each 5–6 mm in diameter. The patient also had a known allergy to nickel. Considering the anatomy and allergy status, embolisation with polyurethane shape memory polymer vascular plugs was considered a good case strategy. The embolisation procedure was technically successful with the deployment of two shape memory polymer plugs into each of the two left ovarian vein branches. Follow-up magnetic resonance imaging at 4 months showed sustained occlusion of the treated vessels and the patient showed no signs of allergy to the implanted material. Conclusions In conclusion, our case presented an opportunity to utilise a new embolic material and achieve a good outcome in a patient with an allergy that may have resulted in complications when using metallic implants.

Background Anomalous left coronary artery from the pulmonary artery is a rare congenital abnormality that requires surgical correction. Case summary We describe the case of a 33-year-old female with a history of anomalous left coronary artery of the pulmonary artery who presents with exertional angina. She underwent a Takeuchi repair that was complicated by a baffle leak. She was successfully treated with left internal mammary artery-left anterior descending (LAD) bypass grafting and percutaneous baffle leak closure. Discussion The Takeuchi procedure involves the creation of an aortopulmonary window and an intrapulmonary tunnel that ‘baffles’ the aorta to the ostium of the anomalous left coronary artery. The most common late complication of the Takeuchi procedure is the presence of a baffle leak. Percutaneous baffle leak occlusion via vascular plug and coronary bypass of the LAD can successfully treat a baffle leak with excellent short-term follow-up.

Background Even though several devices have been developed to facilitate occlusion of cardio vascular structures in adults, only a few types of plugs have been approved in selected pediatric indications. However, apart from patent ductus arteriosus (PDA) closure, little data has been published in children, particularly with regard to the heterogeneity of the procedures and outcomes. Aim To describe the efficacy, safety, and characteristics of the utilization of the Amplatzer Vascular Plug (AVP) II and IV for cardiovascular percutaneous occlusions in children under 10 years. Methods Retrospective multicenter (2006–2020, 6 academic centers) observational review of pediatric transcatheter occlusions using AVP II or IV. Results A total of 125 consecutive children (60 Conclusions AVP II and IV are safe and effective for the percutaneous treatment of numerous cardiovascular lesions in children under ten. In our multicenter experience, such devices represent a real “off-label” pediatric alternative in well-selected patients.

Abernethy malformation is a rare entity. We report a 5-year-old boy presenting with severe pulmonary hypertension in whom Abernethy malformation and inferior caval vein interruption were diagnosed by CT angiography. In addition, the iliac veins were thrombosed with multiple venous collateral drainage. This abnormal venous anatomy caused difficulty in device closure of the Abernethy malformation, which was successfully closed using a vascular plug.

Surgical treatment of acute DeBakey type I aortic dissection does not address the entire aorta, which can leave anatomically complex residual aortic dissection in the aortic arch and descending aorta. Open repair has been the standard treatment for this pathology. When the lesions are located in the aortic arch, re-do total arch replacement needs to be performed. Plug placement to close small entry tears in the aortic arch has been reported. This article reports about a 79-year-old man who underwent hemiarch replacement for acute DeBakey type I aortic dissection. One year later, his proximal descending aorta dilated to 6.3 cm. The patient was treated with Amplatzer plug in the false lumen, and a stent graft was placed in the true lumen. Follow-up computed tomography scan confirmed complete thrombosis of the false lumen in the descending aorta which had decreased from 6.3 to 4.0 cm. Plug placement in the false lumen in the aortic arch is a potential treatment strategy for anatomically complex residual aortic dissection to induce thrombosis of the false lumen and encourage remodeling.

To describe the use of the Amplatzer vascular plug II (AVPII) for transvenous occlusion of patent ductus arteriosus in a non-selective population of dogs, with a focus on the surgical technique, short term outcome and associated complications.Retrospective study. Records of thirty-two consecutive dogs treated for a left-to-right shunting patent ductus arteriosus with the AVPII were reviewed.Ductal occlusion with an AVPII occlusion device was attempted in 32 dogs weighing 1.1-53.8 kg. Transvenous occlusion was successful in 30 dogs. One dog required a transarterial approach for occlusion. One dog died during catheterisation of the right heart but prior to transductal catheterisation. Mean ductal ampulla diameter was 7.9 mm (range, 4.1-15.4 mm) and median size of deployed devices was 10 mm (range 4-20 mm). Mean device to ampulla ratio was 1.34 ± 0.15. Device was positioned in situ with no residual flow on follow-up echocardiographic assessment (one month) in all dogs where deployment was attempted. Occlusion success rate was 96.9% and mortality rate was 3.1%. Four dogs (13.3%) demonstrated minor complications, with none having long-term significance.The use of AVPII device via a transvenous approach is a feasible and effective method for occlusion of a left-to-right shunting patent ductus arteriosus in dogs of a wide range of weight. The method described may complement existing catheter-based occlusion methods.

Background Tubular-shaped (type C) PDA poses a significant challenge for the interventionist. Objectives The aim was to assess the safety and effectiveness of different devices for transcatheter closure of tubular PDA. Methods A retrospective study was performed on all patients who underwent transcatheter closure of PDA at both Cairo and Tanta University Pediatric and Cardiology Departments during the period of 5 years. Results The study included 326 patients aged 7 to 156 months. Twenty-five patients had type C PDA (7.7%). Tubular PDAs with a diameter 1.6-3 mm (5 patients) were closed by an Amplatzer duct occluder (ADO) II and coils, while those 3.1-5 mm in diameter (13 patients) were closed by either an oversized ADOI or an Amplatzer vascular plug (AVP) II. The Amplatzer atrial and ventricular septal devices were used only for 5 patients with type C PDAs. Complete closure was achieved in 76% of type C patients and increased to 96% after one month compared to 74.4% with an increase to 95.3% after one month in patients with other PDA types. Conclusions Different devices can be used successfully to close tubular PDAs in infants and children. AVP II may be a reasonable option in cases with a relatively narrow diameter.

Six patients (mean age, 57.7 y ± 19.7) with persistent urinary fistulae underwent 7 urinary tract embolizations with AMPLATZER Vascular Plugs (AVPs) and glue: 5 with concomitant cavity obliteration with glue and 2 without. A single procedure was successful in resolving urinary leakage in 5 patients (71%) at a mean follow-up of 27.3 wk ± 31.5 (median, 9.7 wk; range, 4.9-80 wk). Repeat cavity embolization was required in 2 instances to achieve clinical success. Mean survival was 42.3 wk (median, 16.4 wk; range, 11.7-104 wk). Combined AVP and glue embolization may prove to be a primary approach in the control of persistent fistulae.

A patient with prior ascending aortic replacement for a type A acute dissection and a bovine arch presented with an asymptomatic chronic dissecting innominate artery aneurysm extending to both carotid arteries. As the patient refused redo open surgery, we performed a hybrid procedure with reverse extra-anatomic aortic arch debranching and a fenestrated endograft. The aneurysm was still partially perfused due to an endoleak and corrected 1 week later with vascular plugs.

Large renal aneurysms can masquerade as simple renal cysts on ultrasound, especially if Doppler examination is not routinely done to assess flow characteristics. We present a case report of a 26-year-old male, as a clinical challenge in urology, who had minimal symptoms, yet had an arteriovenous fistula with a large aneurysm which was diagnosed as a parapelvic cyst on ultrasound. Endovascular treatment of the arteriovenous fistula was done using a vascular plug with satisfactory outcomes.

Hemodynamically significant patent ductus arteriosus (PDA) in preterm infants increases morbidity and mortality. Here we describe a 12-day-old neonate with a huge PDA who developed pulmonary hemorrhage following disseminated intravascular clotting and multiple organ failure. Medical treatment or surgical ligation could not be performed because of the patient's poor condition. Transcatheter closure using a commercially available device (Amplatzer Vascular Plug II) successfully treated the huge PDA without major complications. The Amplatzer Vascular Plug II approach might become a new option for PDA closure in small infants, including those who are critically ill.

A 22-year-old woman presented with new-onset palpitation and dyspnea. Cardiovascular examination revealed continuous murmur at the left upper parasternal area. Echocardiographic evaluation revealed a connection from the aorta, tunneling up to the intra-atrial septum, which made a giant aneurysmal

A 53-year-old diabetic male with sternal dehiscence presented with recurrent staphylococcus bacteremia 2years after coronary artery bypass grafting (CABG). He was found to have a giant right coronary artery (RCA) pseudoaneurysm and a coronary cameral fistula on imaging. Due to excessive surgical risk, the patient underwent percutaneous treatment with a 5mm Amplatzer vascular plug 4 (St. Jude Medical, St.Paul, MN). Post-procedure imaging showed successful cessation of flow into the pseudoaneurysm and follow-up CT scan demonstrated significant improvement in the size of the pseudoaneurysm.

Gastric varices in the setting of portal hypertension occur less frequently than esophageal varices but occur at lower portal pressures and are associated with more massive bleeding events and higher mortality rate. Balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices has been well documented as an effective therapy for portal hypertensive gastric varices. However, BRTO requires lengthy, higher-level post-procedural monitoring and can have complications related to balloon rupture and adverse effects of sclerosing agents. Several modified BRTO techniques have been developed including vascular plug-assisted retrograde transvenous obliteration, coil-assisted retrograde transvenous obliteration, and balloon-occluded antegrade transvenous obliteration. This article provides an overview of various modified BRTO techniques.

Purpose Pulmonary arteriovenous malformations (PAVM) are the direct communications between the pulmonary arteries and veins. These malformations can cause serious complications, and most of these patients should be treated. Herein we present our experience in the treatment of 18 cases of PAVM, treated with endovascular embolisation. Material and methods Eighteen patients with PAVMs underwent endovascular embolisation during a five-year period. Eight were male and 10 were female, with ages ranging from 16 to 65 years. Standard steel coils and vascular plug were used for embolisation. Results Embolisation was successful in 17 of 18 patients. Coiling was used in 10 patients, vascular plug in five, and both materials in two patients. All symptomatic patients with successful embolisation lost all their symptoms after treatment. Control angiography after embolisation showed a closure of AV shunt without migration of embolic material in all patients. Post-embolisation syndrome developed in four patients and late onset of pleural pain in three patients. There was no connection between pleural reaction and type of PAVM and embolic material. Conclusions Endovascular PAVM treatment is a minimally invasive, highly successful method with a low rate of only transitory complications.