Transcatheter Closure of a Chronic Iatrogenic Arteriovenous Fistula Between the Carotid Artery and the Brachiocephalic Vein with an Amplatzer Duct Occluder in Combination with a Carotid Stent

Proximal Occlusion of Medium-Sized Vessels with the Penumbra Occlusion Device: A Study of Safety and Efficacy

PURPOSE

To retrospectively investigate the safety and efficacy of hybrid proximal coiling of various medium-sized vessels (4 to 8 mm) using the Penumbra Occlusion Device (POD).

MATERIALS AND METHODS

From October 2014 to February 2016, 37 proximal embolizations were performed with PODs in 36 patients (mean age: 50.8, range: 10-86; 29 male, 7 female). Vessel occlusions were achieved under fluoroscopic guidance using a 2.7 French microcatheter. Among the 36 vessels targeted, 16 were splenic arteries, 11 renal arteries, 4 mesenteric arteries, 3 arteriovenous fistulae, 1 iliac artery, and 1 gonadal vein. Intermittent follow-up angiography was performed to assess the flow for final occlusion. Outcomes and complications were assessed by clinical and/or imaging follow-up.

RESULTS

To produce proximal occlusion of the intended vessels, the POD was used alone in 19 embolizations (51.4 %). In 12 procedures (32.4 %), POD was used as a coil constrainer to secure the coil construct. In 6 procedures (16.2 %), additional embolic devices were used to achieve vessel occlusion after initial POD deployment. After a mean follow-up of 3.2 months, no POD migration was observed but two complications occurred (5.4 %): one post embolic syndrome and one extensive infarction with splenic abscess.

CONCLUSION

The POD system allows safe and effective proximal embolization of medium-sized vessels in a variety of clinical settings.

A novel endovascular treatment for long-standing high-flow arteriovenous fistula

We describe a novel use of an Amplatzer III plug device (St. Jude Medical, St. Paul, Minn) in the treatment of a traumatic arteriovenous fistula between the innominate vein and the origin of the left common carotid artery causing symptomatic right heart failure. A review of the literature indicates this is the first case to describe the use of the Amplatzer III device in this way. We demonstrate immediate closure of fistula radiologically and complete symptomatic resolution at short-term follow-up.