Embolization with MVP (Micro Vascular Plug\xae): experience on 104 patients in emergent and elective scenarios

Francesco Giurazza,Anna Maria Ierardi,Fabio Corvino,Andrea Contegiacomo,Giampaolo Carrafiello,Raffaella Niola

doi:10.1186/s42155-021-00246-2

Abstract

AimTo describe a 3 years experience of peripheral arterial embolization with Micro Vascular Plug (MVP) (Medtronic, USA).Materials and methodsThe following parameters were investigated: type of vascular injury, anticoagulation therapy at time of procedure, anatomical district, caliper of the target artery, course of the landing zone, additional embolics, technical and clinical success, device related clinical complications. Technical success was defined as complete embolization without deployment of additional embolics after MVP release. Primary clinical success was considered as hemodynamic stability in emergency setting and resolution of the underlying vascular pathology in elective cases; secondary clinical success was considered clinical success after a second embolization session.Results116 MVP have been released in 104 patients (67 males and 37 females; mean age 61.3 years). The pullback release technique was adopted in each case. 85 patients were treated in emergent settings while in 19 patients the procedure was scheduled. The overall technical success was 75%. Primary clinical success was 96.1%, secondary clinical success 3% and clinical failure 0.9%. No statistical differences in terms of effectiveness were observed among patients assuming anticoagulation (p-value = 0.6). A straight and longer landing zone were statistically associated with higher technical success compared to curved and shorter ones, (p-values < 0.001 and = 0.048 respectively). MVP-3 and MVP-5 were the most frequently adopted models in this sample, in 29.8% and 49% of the patients respectively. No clinically adverse events directly related to MVP occurred; in 3 cases device migration was registered without clinical complications.ConclusionMVP is a safe and effective embolic agent. While eventual concomitant anticoagulation therapy did not influence the technical outcome, straight course and length of the landing zone are essential parameters to evaluate before deployment.

Highlights

The Micro Vascular Plug (MVP) (Medtronic, USA) is a mechanical embolic device with control detachment, made of a self-expanding nitinol skeleton ovoid-shaped covered with a polytetrafluoroethylene (PTFE) coating and soldered to a pusher wire (Giurazza et al 2018)
No clinically adverse events directly related to MVP occurred; in 3 cases device migration was registered without clinical complications
While eventual concomitant anticoagulation therapy did not influence the technical outcome, straight course and length of the landing zone are essential parameters to evaluate before deployment

Summary

Introduction

The Micro Vascular Plug (MVP) (Medtronic, USA) is a mechanical embolic device with control detachment, made of a self-expanding nitinol skeleton ovoid-shaped covered with a polytetrafluoroethylene (PTFE) coating and soldered to a pusher wire (Giurazza et al 2018). The first experience description in literature is relatively recent, dated 2014 (Pellerin et al 2014); since few papers (Abdelsalam et al 2020; Bailey et al 2019; Barrett et al 2018; Boatta et al 2017; Conrad et al 2015; Duvnjak et al 2018; Giurazza et al 2019; Jardinet et al 2020; Mahdjoub et al 2018; Ratnani et al 2019), have reported on the use of MVP in interventional radiology focusing on small samples of patients, especially affected by pulmonary arteriovenous malformations.

Objectives

Methods

Results

Discussion

Conclusion