Proximal Occlusion of Medium-Sized Vessels with the Penumbra Occlusion Device: A Study of Safety and Efficacy.

Abstract

To retrospectively investigate the safety and efficacy of hybrid proximal coiling of various medium-sized vessels (4 to 8mm) using the Penumbra Occlusion Device (POD). From October 2014 to February 2016, 37 proximal embolizations were performed with PODs in 36 patients (mean age: 50.8, range: 10-86; 29 male, 7 female). Vessel occlusions were achieved under fluoroscopic guidance using a 2.7 French microcatheter. Among the 36 vessels targeted, 16 were splenic arteries, 11 renal arteries, 4 mesenteric arteries, 3 arteriovenous fistulae, 1 iliac artery, and 1 gonadal vein. Intermittent follow-up angiography was performed to assess the flow for final occlusion. Outcomes and complications were assessed by clinical and/or imaging follow-up. To produce proximal occlusion of the intended vessels, the POD was used alone in 19 embolizations (51.4%). In 12 procedures (32.4%), POD was used as a coil constrainer to secure the coil construct. In 6 procedures (16.2%), additional embolic devices were used to achieve vessel occlusion after initial POD deployment. After a mean follow-up of 3.2months, no POD migration was observed but two complications occurred (5.4%): one post embolic syndrome and one extensive infarction with splenic abscess. The POD system allows safe and effective proximal embolization of medium-sized vessels in a variety of clinical settings.