Amplatzer vascular plug in renal artery embolization: case report and review of the literature

Antonio Catelli,Pietro Venetucci,Umberto Marcello Bracale,Mario Quarantelli,Antonio Corvino,Giovanni Loiudice

doi:10.1186/s43055-020-00279-y

Abstract

BackgroundArterial embolization constitutes a safe and effective therapeutic possibility in the treatment of numerous renal pathologies in election and in urgency. Over the years, numerous embolizing materials have been proposed: fibrin (temporary occlusion), glues, coils, and microspheres. The use of St. Jude Amplatzer vascular plug (AVP) constitutes a more recent and less widespread therapeutic choice, and its use in the renal district is not yet widespread although potentially very valid.Case presentationWe present 3 renal arterial embolizations performed with AVP performed between January 2019 and February 2020: two patients had a very bulky renal heteroplastic lesion and were candidates for nephrectomy, and a third patient instead was affected by a high-flow FAV post-biopsy. In our experience, the use of AVP for the treatment of renal arteriovenous fistula and neoplastic masses has given excellent results without any complications during and after the treatment. In all cases, a single plug was used which perfectly adapted to the target artery resulting in complete occlusion of the vessel in a short time.ConclusionRenal artery embolization performed with AVP has growing potential and numerous advantages in terms of the time of the procedure, speed of embolization, and precision of occlusion, but with a relative increase in costs.

Highlights

Arterial embolization constitutes a safe and effective therapeutic possibility in the treatment of numerous renal pathologies in election and in urgency
Renal artery embolization performed with Amplatzer vascular plug (AVP) has growing potential and numerous advantages in terms of the time of the procedure, speed of embolization, and precision of occlusion, but with a relative increase in costs
We present 3 renal arterial embolizations performed with AVP performed between January 2019 and February 2020: two patients had a very bulky renal heteroplastic lesion and were candidates for nephrectomy, and a third patient instead was affected by a high-flow Renal arteriovenous fistula (FAV) post-biopsy

Summary

Background

Renal artery embolization is an interventional radiology procedure that over the years has proven to be safe and effective in the treatment of numerous pathologies both in election and in urgency: active post-traumatic or post-biopsy bleeding, kidney tumors, arteriovenous fistula (FAV), and vascular malformation [1]. He performed an abdominal angio-CT exam and a subsequent micro-histological biopsy at our interventional radiology department which confirmed the presence of a solid neoplastic mass of 30 × 20 cm in the right kidney. The surgeon indicated excision surgery and required pre-operative embolization to reduce the bleeding risk It was performed after local anesthesia with right common femoral access and selective distal catheterization of the right renal artery with a long-armed introducer. Selective catheterization of the left renal artery with a 5-Fr catheter was performed through 5-Fr right common femoral access; the angiography confirmed high-flow fistula at the meso-renal site. The signs of heart failure decreased significantly after about 6 months after the surgery

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