Efficacy of the Amplatzer Vascular Plug in a Patient Undergoing EVAR for Ruptured Aortoiliac Aneurysm

Takurin Akiyoshi	Masanori Inoue	Tomoki Tamura
Takuma Fukunishi and Hideaki Obara

（Division of Vascular Surgery, Department of Surgery, Department of Radiology, Department of Surgery, Hiratsuka City Hospital, Hiratsuka Japan, and Department of Surgery, Keio University Hospital, Tokyo, Japan）

The purpose of this case report was to discuss the efficacy of The Amplatzer Vascular Plug（AVP）in endovascular aneurysm repair（EVAR）for ruptured aortoiliac aneurysm. A 73-year-old man was referred to our institution with a diagnosis of ruptured abdominal aortic aneurysm（rAAA）by CT scan. The CT scan showed an rAAA of 70mm（Fitzgerald classification 3）and a right common iliac aneurysm of 30mm. The patient was immediately transferred from the ER to the OR and treated with EVAR in combination with occlusion of the right internal iliac artery（IIA）using AVP. The total procedural time was 138 min. The patient recovered uneventfully after the operation with an ICU stay of 2 days and was discharged 9 days after the onset. EVAR has been recognized as a therapeutic option for rAAA in Japan. However, it is not yet been generally adopted as a first-line therapy for rAAA accompanied with iliac aneurysm because of the necessity to occlude IIA. The conventional method with coils to induce thrombosis of IIA is unsuitable for patients in a critical situation for the time required and the difficulty in precise placement. AVP is a nitinol-based self-expanding cylindrical device that is used for arterial embolization. AVP allows assured embolization of IIA in a shorter procedural time, which is essential in an urgent situation. Although AVP is still under post-market surveillance in Japan and only available in limited institutions, the usage of AVP should be considered as an adjunctive procedure in EVAR for rAAA and may expand the limits of endovascular treatment for rAAA.

 

Jpn. J. Cardiovasc. Surg. 43:351-356（2014）

Keywords： ruptured abdominal aortic aneurysm;aortoiliac aneurysm;EVAR;occlusion of hypogastric artery;Amplatzer Vascular Plug