Purpose: The detachable microvascular plug (MVP, Medtronic®, USA) has been recently developed; four models are availalbe according to the size (MVP3-MVP5-MVP7-MVP9). MVP3 and MVP5 are released through a 0.027’’ microcatheter, MVP7 and MVP9 through a 4Fr and 5Fr catheter respectively. This series aims to describe a single center experience examining intraprocedural safety and technical success of MVP adopted in acute hemorrhage embolizations.
Material and Methods: 29 patients (11 women, 18 males; mean age 52.76 years, range: 21-88) have been treated in a single center with arterial embolization using MVP in extracranial districts. All presented clinically with fall in hemoglobin values and/or hemodynamic instability. The bleeding districts were: lower limbs (10), kidneys (7), abdominal wall-epigastric (6), external carotid (2), uterine (1), liver (1), gastroduodenal (1) and bronchial (1). Angiographic signs of bleeding were extravasation of contrast agent and/or pseudoaneurysms. Bleeding etiologies were: traumatic (19), spontaneous (6) and neoplastic (4). MVP size was choosen slightly oversized 15-30% compared to the caliper of the target vessel, because of the vasospasm reaction due to acute bleeding.
Results: MVP3 was choosen in 12 cases, MVP5 in 14 cases and MVP7 in 5 cases; in three patients, two MVP were used. No MVP9 was employed. MVP was successfully released in <1min in all cases except in one where a MVP5 did not detached despite proper positioning, so it was retrieved (technical failure: 3.4%). In 8 patients the MVP was the first and sole embolizing agent employed. In 21 subjects it was positioned complementary after coils; in 4 of them, bleeding continued despite MVP release (uterine, liver, gastroduodenal and bronchial districts). Therefore embolization success after MVP placement was overall obtained in (86.3%). Finally, angiographic success, i.e. bleeding interruption, was obtained in all cases with additional embolics (coils or glue). Clinical success, intended as hemodynamic stability and/or hemoglobin values increase was always achieved (100%).
Conclusions: MVP seems to be a safe embolizing device that interventionalist should consider when facing arterial embolization; the main advantage seems to be related to MVP3 and MVP5 models that can be adopted for distal embolization thanks to the precise release through 0.027’’microcatheter, especially in proximity of bifurcation; the main technical limit is the need for a straight vessel segment of almost 12mm for proper plug landing.
.jpg "Francesco Giurazza, MD, PhD, EBIR photo")