Utility of the Amplatzer Vascular Plug in Splenic Artery Embolization: A Comparison Study with Conventional Coil Technique

Abstract

To retrospectively evaluate the role of the Amplatzer Vascular Plug (AVP) in proximal splenic artery embolization (SAE) compared with coils. Forty patients had proximal SAE performed with AVP(s) or coils as the primary embolic agent for splenic artery steal syndrome (n=23), trauma (n=5), portal hypertension (n=5), bleeding due to pancreatic pathology (n=4), and pre-splenectomy (n=3). Comparisons were made of occlusion and procedure time, cost, and radiation dose. Eighteen proximal SAE procedures were successfully performed with AVP. Twenty-two procedures were performed with coils, including one failed AVP attempt, which was completed with coils. Precise deployment without migration was achieved in all 18 AVP cases. Seven of 22 (31.8%) coil procedures had distal migration without consequence. There was no statistically significant difference in mean occlusion time (24.4 min for AVP vs. 31.5 min for coils, P=0.13), procedure time (43.7 min for AVP vs. 53.8 min for coils, P=0.16), or cost ($1474.13 for AVP vs. $1722.51 for coils, P=0.69). There was significant difference in radiation dose (842 mGy for AVP vs. 1,309 mGy for coils, P=0.04). Fourteen of the 18 (78%) AVP devices required additional embolic material. AVP with additional embolic agents is a useful alternative for proximal SAE because of precise deployment, resistance to migration, and radiation reduction. AVP use may be limited by vessel tortuosity. The occlusion time, procedure time, and cost were reduced but this was not statistically significant due to the need for additional embolic material.