James Thuan Bui MD, Presenter: Nothing to Disclose

Ron Charles Gaba MD, Abstract Co-Author: Nothing to Disclose

Derek Lamont West MD, Abstract Co-Author: Nothing to Disclose

Charles A. Owens MD, Abstract Co-Author: Nothing to Disclose

The Amplatzer vascular plug (AVP; AGA Medical, Golden Valley, MN) is a recently developed, self-expanding metallic device indicated for peripheral vascular embolizations. Herein, we describe a previously unreported use of this device in the treatment of vascular complications related to surgically-fashioned arteriovenous hemodialysis fistulas.

Four patients with problematic brachiocephalic or brachiobasilic arteriovenous fistulas underwent fistula occlusion using the AVP. Procedure indications included vascular steal syndrome, consisting of upper extremity sensory and motor deficits, in three patients, and enlarging vascular aneurysms in one patient. Contraindications for surgical correction were determined by the primary surgeon(s). Using an arm approach, embolizations were performed through 5 or 6 Fr vascular sheaths positioned within the segment of vein just beyond the arteriovenous anastomosis. An AVP ~ 50% larger in diameter than the vein segment was used. Noninvasive evaluation of the involved extremity was performed pre and post embolization in addition to clinical follow-up examinations.

Technical success was 100%, with complete arteriovenous fistula occlusion accomplished in all cases. An average of 1.6 AVP/patient was used to treat the three patients with vascular steal syndrome. Two AVPs and two metallic coils were used in the single patient with an expanding aneurismal fistula. Angiographic improvement in distal arterial flow was immediately evident and resolution of clinical symptoms occurred in all patients. No procedure-related complications were encountered, and the patients were discharged the following day.

The Amplatzer vascular plug provides a minimally invasive and efficacious method for embolization of problematic arteriovenous fistulas.

Problematic hemodialysis fistulas can be effectively embolized using the Amplatzer vascular plug when surgical treatment is not immediately available or when conventional coil embolism would be difficult.

Bui, J, Gaba, R, West, D, Owens, C, Amplatzer Vascular Plug for Treatment of Problematic Hemodialysis Fistulas.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4431165.html