Transluminal hypogastric artery occlusion with an Amplatzer vascular plug during endovascular aortic aneurysm repair
Received 20 February 2008; accepted 1 June 2008. published online 11 August 2008.
Objective
To evaluate our initial experience with hypogastric artery occlusion using a nitinol vascular plug during endovascular aortic aneurysm repair (EVAR).
Methods
We reviewed the records and images of 23 consecutive patients who underwent transluminal vessel occlusion of the hypogastric artery with a nitinol plug, as well as a cohort of 19 patients who underwent hypogastric artery embolization with coils in conjunction with EVAR.
Results
There were no demographic differences between the two groups of patients. Hypogastric artery occlusion was successful in all cases when a nitinol vascular plug was used. When coils were used, there was one unsuccessful embolization which required a second procedure. The number of embolic devices used in the coil group was 7.53 (range, three to 13) compared with 1.35 (range, one to six) in the plug group (P < .05). Only one plug was used in 19 of 23 cases. The average cost to embolize per hypogastric artery was $1,496 compared with $470 when a nitinol plug was used. There were two instances of coil migration. No other intraoperative complications occurred. At one month follow up, seven patients (35%) in the coil group complained of buttock claudication compared with two patients (9%) in the nitinol plug group (P = .027).
Conclusion
Our experience demonstrates the safety and effectiveness of the nitinol vascular plug for hypogastric artery occlusion during EVAR. When compared with coils for hypogastric embolization during EVAR, nitinol vascular plugs are less expensive, produce less technical complications, and are associated with a significantly lower incidence of gluteal claudication.
aCardiovascular Center, Sections of Vascular Surgery, University of Michigan School of Medicine, Ann Arbor, Mich
bInterventional Radiology, University of Michigan School of Medicine, Ann Arbor, Mich
Reprint requests: Enrique Criado, MD, Section of Vascular Surgery, University of Michigan School of Medicine, CVC 5463, 1500 E. Medical Center Dr., SPC 5867, Ann Arbor, MI 48109-5867
ABSTRACT