Edwards M - AIMRADIAL 2014 Endovascular - Amplatzer in visceral arteries
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Placement of Amplatzer vascular plug 4 via transradial approach in the visceral arteries
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Edwards M - AIMRADIAL 2014 Endovascular - Amplatzer in visceral arteries
- 1. Placement of Amplatzer Vascular Plug 4 Via Transradial Approach in the Visceral Arteries Martin Edwards MD, Rahul Patel MD, and Aaron Fischman MD Department of Radiology Mount Sinai Medical Center
- 2. Purpose/Disclosures • Purpose • To determine the technical success and effectiveness of placing the Amplatzer Vascular Plug 4 (AVP4) from a radial approach. • Disclosures • Dr. Aaron Fischman – Terumo Interventional Systems (consultant) • Dr. Rahul Patel – none • Dr. Martin Edwards - none
- 3. Background • Factors to consider when choosing embolization technique: • Technical success • Cost • Procedure time • Extent of occlusion • Nontarget embolization • Transradial approach versus transfemoral • Improved patient satisfaction • Reduced recovery times • Safe and effective
- 4. Background – AVP 4 • Amplatzer plugs designed for peripheral vessel single device occlusion • Amplatzer Vascular Plug 4 (AVP4) FDA approved in 2012 • Self-expandable device composed of two nitinol mesh wire lobes • Deployable via 0.038” diagnostic catheter • Controlled delivery and re-deployable • Multiple sizes • 11 mm length • 4-8 mm diameter
- 5. Methods • Retrospective single center review 4/1/12 – 6/30/14 • 845 patients • AVP4 placement attempted in 20 patients in 21 vessels • Endpoints: • Technical success • Effectiveness – defined by complete vessel occlusion (CVO) at time of deployment and follow-up DSA/CT/MRI
- 6. Results • Technical success: 100% • AVP4 diameter: • 6mm: 10 • 8mm: 11 • Mean fluoroscopy time: • 28 minutes (range 8-40) • Effectiveness: 83% • 15/18 vessels w CVO • 2 recanalized GDA • Adverse events: none Vessel # Gastroduodenal artery 15 Right gastric artery 2 Left gastric artery 1 Splenic artery 1 Right inferior phrenic artery 1 Catheter # 5F Sarah Radial 110 cm 17 4F Tempo Aqua 125 cm 2 4F Cobra 100 cm 1
- 8. Gastric
- 11. Discussion • AVP4 • Retrievable and redeployable • No cases of followup collateralization • Unpredictable occlusion time? • generally high-flow vessels in coagulopaths • up to 15 minutes for hemostasis • can adjunct with glue, gelfoam or coil
- 12. Discussion • Multiple coils versus 1 x AVP4 • Cost • Procedure time • Inventory • Sometimes you need it all Source: St. Jude Medical at www.sjm.com referencing data from Pech M, Kraetsch A, Wieners G, et al. Embolization of the Gastroduodenal Artery Before Selective Internal Radiotherapy: A Prospectively Randomized Trial Comparing Platinum-Fibered Microcoils with the Amplatzer Vascular Plug II. Cardiovasc Intervent Radiol. 2009;32(3)455-61.
- 13. Discussion • Radial access • No access site complications • No neurologic adverse events • Patients ambulate immediately • TR band for 90 minutes • Limitations? • Catheter length • AVP4 can be advanced through a standard 0.038” diagnostic catheter • Vessel angulation • Radial artery occlusion • No incidences in our cohort
- 14. Conclusion • AVP4 placement in visceral arteries from a transradial approach is technically feasible, safe and effective