Amplatzer Plug Evaluated to Occlude the Internal Iliac Artery During EVAR

February 17, 2016—A large, multicenter study evaluated the use of the Amplatzer plug (St. Jude Medical, Inc.) to occlude the internal iliac artery (IIA) during endovascular aortic aneurysm repair (EVAR). Edouard Warein, MD, et al published the study’s findings online ahead of print in the European Journal of Vascular and Endovascular Surgery (EJVES).

The background of the study is that in the absence of a distal iliac landing zone during EVAR, the Amplatzer plug is increasingly being used to replace other IIA embolization techniques. This study aimed to assess the technical success, complication occurrence, and durability of the Amplatzer plug for IIA embolization.

As summarized in EJVES, the study included 169 consecutive patients who underwent internal iliac embolization with an Amplatzer plug during an EVAR procedure from 2007 through 2013. The patients (160 men, 9 women; mean age 75 ± 9 years) predominantly included unilateral embolization of the IIA (93%), performed either separately before (38.5%) or during EVAR (61.5%). Follow-up CT scans and/or ultrasound scans were performed 1 month after treatment and yearly thereafter. Although the inclusions were done retrospectively, the series was continuous and consecutive. Data were collected and analyzed using acquisition REDCap software.

The investigators reported that the technical success rate was 97.6%. Failures included one case of device migration, two instances of navigation failure, and one release outside of the target zone. On average, 1.43 plugs were required to achieve the embolization. Other complications included buttock claudication (24.3%), which resolved by the first follow-up in most cases (58.5%, 24/41), and intestinal ischemia requiring limited bowel resection observed in two cases.

This multicenter study demonstrates the efficacy and reliability of the Amplatzer plug to embolize the IIA during EVAR with few side effects, concluded the investigators in EJVES.