Abstract
The Amplatzer Vascular Plug Type II (AVP II) has proven effective in the therapeutic embolization of various vascular lesions. It benefits from very rapid occlusion of the target lesion and can be deployed, retrieved, and redeployed if required. There is no literature available on use of the AVP II in the maintenance, closure, and management of complicated arteriovenous access in hemodialysis patients. In this series, we present our clinical experience with the use of the AVP II for embolization of problematic hemodialysis access. The AVP II is a self-expandable Nitinol wire-mesh device. Mounted on a delivery wire it has the capability to be deployed, recaptured, and redeployed. In total seven patients (four males: one diabetic, all nonsmokers), with ages ranging from 44 to 81 years (mean, 63 years), were treated between July 2008 and January 2009. One patient had not started dialysis. The remaining six patients had varied histories, with the time on hemodialysis ranging from 1 to 21 years. Retrospective review of clinical notes revealed patient demographics, type of access, device size, deployment site, and outcomes. Indications for embolization included steal syndrome (one patient), high-flow tributaries (two patients), and limb swelling (four patients). All patients had clinical and sonographical follow-up to 3 months. Surgical ligation had either failed, was considered a contraindication due to concerns regarding wound healing, or was considered difficult due to complex venous anatomy. Only one device was used in each patient, ranging from 6 to 16 mm in diameter. Immediate technical success was seen in 100%. All these patients were followed up clinically in the vascular access radiology clinic at 4 weeks and 3 months. Occlusion of the treated vessel and resolution of symptoms were reconfirmed in 100% of cases at 3 months. It was also noted whether patients were having successful dialysis, if required. There were no complications. Average procedural time was 19 min. We conclude that the AVP II is an efficient, safe, and technically simple occlusion device for use in arteriovenous access.
Similar content being viewed by others
References
Grassman A, Gioberge S, Moeller S et al (2005) ESRD patients in 2004: global overview of patient numbers, treatment modalities and associated trends. Nephrol Dialysis Transpl 20(12):2587–2593
National Kidney Foundation (2006) Clinical practice guidelines for vascular access. Am J Kidney Dis 48(1):248–273
Robbin M, Chamberlain N, Lockart M et al (2002) Hemodialysis arteriovenous fistula maturity: US evaluation. Radiology 225(1):59–64
Surlan M, Popovic P (2003) The role of interventional radiology in management of patients with end-stage renal disease. Eur J Radiol 46(2):96–114
Gelbfish GA (2007) Surgical versus percutaneous care of arteriovenous access. Semin Vasc Surg 20(3):167–174
Vorwerk D (2002) Nontraumatic vascular emergencies: management of occluded hemodialysis shunts and venous success. Eur Radiol 12(11):2644–2650
Owens CA, Bui JT, West DL et al (2007) Use of Amplatzer Vascular Plug as a coil constrainer during occlusion of a dialysis shunt. CardioVasc Interv Radiol 30(4):754–756
Tabori NE, Love BA (2008) Transcatheter occlusion of pulmonary arteriovenous malformations using the Amplatzer Vascular Plug II. Cath Cardiovasc Interv 71(7):940–943
Pech M, Kraetsch A, Wieners G et al (2009) Embolization of the gastroduodenal artery before selective internal radiotherapy: a prospectively randomized trial comparing platinum-fibered microcoils with the Amplatzer Vascular Plug II. CardioVasc Interv Radiol 32(3):455–461
Yoo H, Ko GY, Gwon DI et al (2009) Preoperative portal vein embolization using an Amplatzer Vascular Plug. Eur Radiol 19(5):1054–1061
Bui JT, Gaba RC, Knuttinen MG et al (2009) Amplatzer Vascular Plug for arteriovenous hemodialysis access occlusion: initial experience. J Vasc Access 10(1):5–10
Elsharawy MA, Moghazy KM (2005) Pre-operative evaluation of hemodialysis access fistula. A multidisciplinary approach. Acta Chir Belg 105(4):355–358
Flu H, Breslau PJ, Krol-van Straaten JM et al (2008) The effect of implementation of an optimized care protocol on the outcome of arteriovenous hemodialysis access surgery. J Vasc Surg 48(3):659–668
Turmel-Rodrigues L, Pengloan J, Baudin S et al (2000) Treatment of stenosis and thrombosis in haemodialysis fistulas and grafts by interventional radiology. Nephrol Dial Transplant 15(12):2029–2036
Kolakowski S Jr, Dougherty MJ, Calligaro KD (2003) Salvaging prosthetic dialysis fistulas with stents: forearm versus upper arm grafts. J Vasc Surg 38(4):719–723
Nassar GM (2008) Endovascular management of the “failing to mature” arteriovenous fistula. Tech Vasc Interv Radiol 11(3):175–180
Singh P, Robbin M, Lockhart ME et al (2008) Clinically immature arteriovenous hemodialysis fistulas: effect of US on salvage. Radiology 246(1):299–305
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Powell, S., Narlawar, R., Odetoyinbo, T. et al. Early Experience with the Amplatzer Vascular Plug II for Occlusive Purposes in Arteriovenous Hemodialysis Access. Cardiovasc Intervent Radiol 33, 150–156 (2010). https://doi.org/10.1007/s00270-009-9755-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-009-9755-8