Aortopulmonary collaterals connect the systemic and pulmonary circulations, benefiting pulmonary blood flow but also increasing pulmonary pressure and risk of hemoptysis. The Amplatzer vascular plug was created as a modification of septal occluders to embolize vessels, consisting of a nitinol mesh disk delivered via a torqueable wire. It promotes clot formation to occlude vessels and can be retrieved or repositioned before detachment. While it reduces risks like migration in high flow situations, challenges include device advancement, persistent patency, and cost.

1. Aortopulmonary collaterals

2. Systemic to pulmonary circulation.
Beneficial effect – increased pulmonary blood flow.
Negative effects –
• Limits the lower saturated blood flow from the lungs.
• Increase PA pressure
• Volume overload
• Hemoptysis

3. Clinical impact of APCs
• Catheter Angiography
• Phase contrast MR
• Measurement of pulmonary venous effluent
during CPB
• Thermal dilution technique
• Lung perfusion scintigraphy

4. Amplatzer vascular plug
• was created for peripheral embolization as a
modification of the family of Amplatz septal occluders.
• Multiple versions - the size of the introducer’s system,
number of layers, and resultant thrombogenicity.
• St. Jude Medical, St. Paul, MN.
• a disk made of a mesh of braided nitinol.

5. • The disk is attached to a 155-cm-long, PTFE-coated
delivery wire with a stainless-steel micro screw, which
allows the operator to release the plug into the final
position by rotating the cable in a counter clockwise
fashion using a supplied torque device.
• The plug can be retrieved and readjusted as needed
before final release.
• It has platinum marker bands at the ends to increase
radiopacity.

6. • The AVP is compatible with MRI.
• The AVP acts as an embolic agent by promoting clot
formation.
• The resistance to blood flow created by the nitinol
mesh facilitates fibrin coverage during the clotting
process.
• It is recommended to oversize the device by 30 to 50%
of the estimated diameter of the vessel.

7. • Large vessel size, high-flow situations, and abnormal
coagulation factors can prolong the occlusion time with the
AVP.
• The number of bodies of the plug and the final diameter of
the vessel are important factors to determine the final length
of the device.

8. Advantages
• has minimal risk of migration even in high-flow situations or in
short landing zones.
• The delivery mechanism also allows repositioning.
• It is possible to achieve occlusion of a large diameter vessel
with a single device rather than multiple coils.

10. Challenges
• Device advancement
• Persistent patency
• Plug detachment
• Contrast injection
• Vessel recanalization
• Device cost
• Device migration

11. Other uses
• Embolization of Aortoiliac Segments
• Pulmonary Arteriovenous Malformations
• Splenic Artery Embolization
• Arteriovenous Fistulas Embolization
• Gastric Varices and Balloon-Assisted Retrograde Transvenous
Obliteration
• Preoperative Portal Vein Embolization