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Fujioka S, Kitamura T, Mishima T, Mori H, Fukuzumi M, Shikata F, Miyaji K. Coil-in-Plug Method for Left Subclavian Artery Embolization in Thoracic Endovascular Aortic Repair with Arch Vessel Debranching. Ann Vasc Dis 2023; 16:189-194. [PMID: 37779651 PMCID: PMC10539117 DOI: 10.3400/avd.oa.23-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/04/2023] [Indexed: 10/03/2023] Open
Abstract
Objectives: Since 2018, we have routinely placed an Amplatzer vascular plug (AVP) in the proximal left subclavian artery (LSCA) to prevent embolic events during thoracic endovascular aortic repair with arch vessel debranching (d-TEVAR). Type II endoleaks of LSCA origin were observed in two patients (20%), and the coil-in-plug (CIP) method, i.e., microcatheter insertion through the plug and addition of coil embolization, which has been used since August 2019, was performed. This study aims to evaluate the effectiveness of the CIP method for LSCA embolization. Methods: A total of 26 patients who underwent d-TEVAR for an aortic arch aneurysm between 2018 and 2022 were retrospectively reviewed. Ten patients who underwent d-TEVAR with a simple AVP placement (the control group) and 16 patients who underwent d-TEVAR with the CIP method (the CIP group) were compared. Results: Two patients had type II endoleaks in the control group, whereas none had them in the CIP group. LSCA length was significantly shorter in patients with endoleaks than in those without endoleaks (24.5 vs. 50.3 mm; p<0.01). No perioperative deaths or cerebral infarctions occurred in either group. Conclusions: AVP placement in the LSCA during d-TEVAR effectively prevented perioperative cerebral infarction. d-TEVAR with CIP was especially useful in patients with a short LSCA.
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Affiliation(s)
- Shunichiro Fujioka
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Tadashi Kitamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Toshiaki Mishima
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hisaya Mori
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Masaomi Fukuzumi
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Fumiaki Shikata
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Matsumoto K, Ohuchi Y, Yata S, Adachi A, Endo M, Takasugi S, Fujii S, Hashimoto M, Kaminou T, Ogawa T, Fujiwara Y, Saiki M, Nishimura M. Compressed Amplatzer Vascular Plug II Embolization of the Left Subclavian Artery for Thoracic Endovascular Aortic Repair is Efficient and Safety Method Comparable to Conventional Coil Embolization. Yonago Acta Med 2019. [DOI: 10.33160/yam.2019.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Kensuke Matsumoto
- *Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yasufumi Ohuchi
- *Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Shinsaku Yata
- *Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Akira Adachi
- *Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Masayuki Endo
- *Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Shohei Takasugi
- *Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Shinya Fujii
- *Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Masayuki Hashimoto
- †Department of Radiology, Tottori Municipal Hospital, Tottori 680-8501, Japan
| | - Toshio Kaminou
- ‡Department of Radiology, Osaka Minami Medical Center, Kawachinagano 586-8521, Japan
| | - Toshihide Ogawa
- §Department of Radiology, Kurashiki Heisei Hospital, Kurashiki 710-0826, Japan
| | - Yoshikazu Fujiwara
- Division of Organ Regeneration Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Munehiro Saiki
- ¶Department of Cardiovascular surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima 730-8518, Japan
| | - Motonobu Nishimura
- Division of Organ Regeneration Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
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Seike Y, Matsuda H, Inoue Y, Omura A, Uehara K, Fukuda T, Kobayashi J. Balloon protection of the left subclavian artery in debranching thoracic endovascular aortic repair. J Thorac Cardiovasc Surg 2018; 157:1336-1345.e1. [PMID: 30447961 DOI: 10.1016/j.jtcvs.2018.10.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 09/25/2018] [Accepted: 10/11/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Since 2012, we have routinely applied balloon protection of the proximal left subclavian artery to prevent embolic events through the left vertebral artery during debranching thoracic endovascular aortic repair. This study aimed to study the effectiveness of balloon protection of the proximal left subclavian artery. METHODS We reviewed the medical records of 157 patients who underwent debranching thoracic endovascular aortic repair between 2007 and 2017. Of these, 71 patients for whom balloon protection of the proximal left subclavian artery was used were assigned to the balloon protection of the proximal left subclavian artery group (58 men; age: 78 ± 6.7 years), and 86 patients were assigned to the control group (66 men; age: 78 ± 8.9 years). A total of 51 patients from each group were matched by their propensity scores to adjust for differences in the patients' characteristics. RESULTS Perioperative stroke was significantly lower in the balloon protection of the proximal left subclavian artery group than in the control group (0%: 0/71 vs 7.9%: 7/86, P = .014). Freedom from all causes of mortality at 2 and 4 years was significantly higher in the balloon protection of the proximal left subclavian artery group compared with the control group (93%/76% vs 77%/59%, P = .015). Freedom from aortic death at 2 and 4 years was similar in both groups (97%/97% vs 91%/86%, P = .094). Propensity score matching yielded similar results of better freedom from all causes of mortality in the balloon protection of the proximal left subclavian artery group (93%/93% vs 81%/63%, P = .017) and equivalent aortic death in both groups (95%/95% vs 92%/88%, P = .30). CONCLUSIONS Debranching thoracic endovascular aortic repair using balloon protection of the proximal left subclavian artery demonstrated more appropriate early and late outcomes. Evaluation using propensity score matching enhanced the efficacy of balloon protection of the proximal left subclavian artery.
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Affiliation(s)
- Yoshimasa Seike
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Yosuke Inoue
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Atsushi Omura
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kyokun Uehara
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tetsuya Fukuda
- Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
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Onzuka T, Oishi Y, Uchiyama H, Ochiai Y, Nakashima A, Shinozaki K. A Case of Tandem Plug Embolization for an Aberrant Right Subclavian Artery during Debranching Thoracic Endovascular Aortic Repair. Ann Vasc Dis 2016; 9:228-231. [PMID: 27738469 DOI: 10.3400/avd.cr.16-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 06/27/2016] [Indexed: 11/13/2022] Open
Abstract
Aberrant right subclavian artery embolization is problematic in debranching thoracic endovascular aortic repair, because concomitant bypass grafting to the right upper arm may hinder complete embolization. We report a case of a thoracic aortic aneurysm with aberrant right subclavian artery successfully treated with debranching thoracic endovascular aortic repair and bypass grafting. Although endoleakage was found from aberrant right subclavian artery after single use of Amplatzer vascular plug, additional deployment of Amplatzer vascular plug II completely eliminated residual endoleakage. This simple technique is useful for the aberrant right subclavian artery embolization in debranching thoracic endovascular aortic repair.
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Affiliation(s)
- Tatsushi Onzuka
- Department of Cardiovascular Surgery, JCHO Kyushu Hospital, Kitakyushu, Fukuoka, Japan
| | - Yasuhisa Oishi
- Department of Cardiovascular Surgery, Kyushu University Hospital, Fukuoka, Fukuoka, Japan
| | - Hikaru Uchiyama
- Department of Cardiovascular Surgery, JCHO Kyushu Hospital, Kitakyushu, Fukuoka, Japan
| | - Yoshie Ochiai
- Department of Cardiovascular Surgery, JCHO Kyushu Hospital, Kitakyushu, Fukuoka, Japan
| | - Atsuhiro Nakashima
- Department of Cardiovascular Surgery, JCHO Kyushu Hospital, Kitakyushu, Fukuoka, Japan
| | - Kenji Shinozaki
- Departments of Radiology, JCHO Kyushu Hospital, Kitakyushu, Fukuoka, Japan
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Iida Y, Ito T, Hayashi S, Takahashi T, Misumi T, Hachiya T, Shimizu H. Repair of Acute Type B Aortic Dissection Complicated by Aortic Rupture with Debranching Thoracic Endovascular Aortic Repair and Left Subclavian Artery Occlusion Using Amplatzer Vascular Plug II. Ann Vasc Dis 2015; 8:252-4. [PMID: 26421077 DOI: 10.3400/avd.cr.15-00040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/27/2015] [Indexed: 11/13/2022] Open
Abstract
An 88-year-old man with severe chest pain and syncope was admitted to our hospital. Contrast-enhanced computed tomography (CT) revealed acute type B aortic dissection with rupture. Considering age and operative risk, we performed emergency thoracic aortic endovascular repair with two-debranching of the left common carotid and left subclavian arteries. To prevent type II endoleak, we used Amplatzer Vascular Plug (AVP) II for left subclavian artery embolization. Postoperative contrast-enhanced CT showed no type II endoleak and rupture site exclusion. As postoperative persistent blood flow to the primary entry or rupture site causes re-rupture, AVP II was crucial in preventing type II endoleak.
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Affiliation(s)
- Yasunori Iida
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Tsutomu Ito
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Sachiko Hayashi
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Tatsuo Takahashi
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Takahiko Misumi
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Takashi Hachiya
- Department of Cardiovascular Surgery, Keio University, Tokyo, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University, Tokyo, Japan
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Runge V, Pieper CC, Schiller W, Praeger AJ, Probst C, Wilhelm KE. Endovascular repair of an ductus arteriosus aneurysm causing Ortner syndrome. Vasc Endovascular Surg 2014; 48:271-4. [PMID: 24420059 DOI: 10.1177/1538574413518607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A ductus arteriosus aneurysm (DAA) is a rare but potentially fatal condition in adults. In the past, open surgery was the only available option for treatment. Nowadays, endovascular repair has emerged as a safe and less invasive treatment option for aortic aneurysms. However, there is little experience with DAA and its anatomic location can complicate endovascular repair. Here, we describe the case of a 69-year-old patient who presented with Ortner syndrome caused by DAA, which was successfully treated using a solely endovascular approach and a standard stent graft.
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Affiliation(s)
- Vivian Runge
- Department of Radiology, Royal Melbourne Hospital, Victoria, Australia
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Bulla K, Hubich S, Pech M, Löwenthal D, Ricke J, Dudeck O. Superiority of proximal embolization of the gastroduodenal artery with the Amplatzer vascular plug 4 before yttrium-90 radioembolization: a retrospective comparison with coils in 134 patients. Cardiovasc Intervent Radiol 2013; 37:396-404. [PMID: 23842683 DOI: 10.1007/s00270-013-0684-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 04/23/2013] [Indexed: 01/15/2023]
Abstract
PURPOSE To evaluate the effectiveness of proximal embolization of the gastroduodenal artery (GDA) using the Amplatzer Vascular Plug 4 (AVP 4) compared with pushable coils to avoid hepaticoenteric collaterals of the GDA stump, which may serve as pathways for nontarget embolization. MATERIALS AND METHODS One hundred thirty-four patients scheduled for 90-yttrium radioembolization (Y-90 RE) using either plugs (n = 67) or standard coils (n = 67) for GDA occlusion were retrospectively analyzed. Parameters recorded were length of the perfused GDA stump, distance device to the GDA origin, perfused proximal side branches after embolization, and durability of vessel occlusion at Y-90 RE. RESULTS Length of the residually perfused GDA stump was 3.89 ± 2.86 mm for the AVP 4, which was significantly shorter compared with 5.78 ± 3.85 mm for coils (p = 0.005). Distance of the plug to the GDA origin was 1.41 ± 2.60 mm, which was also significantly shorter than 4.73 ± 3.44 mm for coils (p < 0.001). This resulted in significantly fewer patients with residually perfused side branches in the AVP 4 group (n = 2; 3.0%) compared with the coil group (n = 18; 26.9%; p < 0.001). At Y-90 RE, no GDA reperfusion was found after plug embolization compared with 2 cases after coil embolization (3.0%; p = 0.156). Only one patient had a radiation-induced duodenal ulcer after coil embolization, whereas no Y-90-related toxicity was identified after plug embolization. CONCLUSION Use of the AVP 4 for embolization of the GDA allowed an optimal proximal and more effective target vessel occlusion compared with coil embolization, which can avoid complications caused by extrahepatic gastrointestinal deposition of Y-90 microspheres by way of residually perfused proximal side branches.
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Affiliation(s)
- Karsten Bulla
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany,
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The Amplatzer Vascular Plug: A Review of the Device and its Clinical Applications. Cardiovasc Intervent Radiol 2012; 35:725-40. [DOI: 10.1007/s00270-012-0387-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 03/25/2012] [Indexed: 12/16/2022]
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9
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Marone EM, Mascia D, Kahlberg A, Tshomba Y, Chiesa R. Emergent endovascular treatment of a bleeding recurrent aortoenteric fistula as a “bridge” to definitive surgical repair. J Vasc Surg 2012; 55:1160-3. [DOI: 10.1016/j.jvs.2011.10.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 10/05/2011] [Accepted: 10/05/2011] [Indexed: 11/30/2022]
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Teichgräber UK, De Bucourt M. Massive retroperitoneal hemorrhage from a giant renal angiomyolipoma treated by selective arterial embolization with an Amplatzer Vascular Plug II. Acta Radiol Short Rep 2012; 1:10.1258_arsr.2012.110029. [PMID: 23986834 PMCID: PMC3738343 DOI: 10.1258/arsr.2012.110029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 02/17/2012] [Indexed: 12/21/2022] Open
Abstract
We report on a 36-year-old Caucasian woman who presented to the emergency department with post-traumatic retroperitoneal bleeding diagnosed by computed tomography. After clinical stabilization of the patient, selective arterial embolization was performed. The angiomyolipoma's feeding artery was successfully treated with an 8-mm Amplatzer Vascular Plug Type II. The upper pole of the left kidney, which was supplied by a separate upper renal artery, was conserved. Consequently, the renal angiomyolipoma became necrotic and surgical resection of the entire renal angiomyolipoma was performed. This case illustrates a simple and effective application of an Amplatzer Vascular Plug occluder for vessel embolization, without additional coiling.
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Affiliation(s)
- Ulf Km Teichgräber
- Department of Radiology, Jena University Hospital , Germany ; Department of Radiology, Charité University Hospital Berlin , Germany
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Maleux G, Vaninbroukx J, Heye S. Failed surgical ligation of the proximal left subclavian artery during hybrid thoracic endovascular aortic repair successfully managed by percutaneous plug or coil occlusion: a report of 3 cases. J Cardiothorac Surg 2011; 6:45. [PMID: 21477301 PMCID: PMC3090327 DOI: 10.1186/1749-8090-6-45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 04/08/2011] [Indexed: 11/28/2022] Open
Abstract
Open surgical rerouting and proximal ligation of one or more supra-aortic vessels prior to endovascular stent-graft placement has become an alternative to major open thoracic surgery in the treatment of complex thoracic aortic disease. Complications owing to failed surgical ligation of the left subclavian artery are rare. In this report, 3 cases of failed ligation are presented. Diagnosis was made by CT-scan and treatment was performed by transcatheter coil and plug embolization, avoiding redo neck surgery.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Leuven, Belgium.
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Pech M, Mohnike K, Wieners G, Seidensticker R, Seidensticker M, Zapasnik A, Ricke J, Dudeck O. Advantages and Disadvantages of the Amplatzer Vascular Plug IV in Visceral Embolization: Report of 50 Placements. Cardiovasc Intervent Radiol 2011; 34:1069-73. [DOI: 10.1007/s00270-011-0150-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Accepted: 12/10/2010] [Indexed: 11/30/2022]
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Canyigit M, Gumus M, Kilic E, Erol B, Cetin H, Hasanoglu HC, Arslan H. Aneurysm of an Anomalous Systemic Artery Supplying the Normal Basal Segments of the Left Lower Lobe: Endovascular Treatment with the Amplatzer Vascular Plug II and Coils. Cardiovasc Intervent Radiol 2010; 34 Suppl 2:S126-30. [DOI: 10.1007/s00270-010-9827-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Accepted: 02/08/2010] [Indexed: 12/01/2022]
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Successful embolization of a spontaneous mesocaval shunt using the Amplatzer Vascular Plug II. Cardiovasc Intervent Radiol 2009; 33:1044-8. [PMID: 19908090 DOI: 10.1007/s00270-009-9739-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 10/08/2009] [Indexed: 12/27/2022]
Abstract
A 48-year-old man with alcoholic liver cirrhosis and hepatic encephalopathy was found to have a large, spontaneous mesocaval shunt. The shunt was successfully occluded with the use of an Amplatzer Vascular Plug. To our knowledge, this is the first report of the use of this device to embolize a mesocaval shunt involving the superior mesenteric vein.
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Ferro C, Rossi UG, Bovio G, Petrocelli F, Seitun S. The AMPLATZER Vascular Plug 4: Preliminary Experience. Cardiovasc Intervent Radiol 2009; 33:844-8. [DOI: 10.1007/s00270-009-9749-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 10/22/2009] [Indexed: 11/24/2022]
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