Occlusion Plug Research Articles

Novel Technique for Intentional Occlusion of Directional Branches During Complex Endovascular Aortic Repair Using Microvascular Plugs.

To demonstrate the feasibility and outcomes of using the microvascular plug (MVP) for intentional occlusion of directional branches (DB) during complex endovascular aortic procedures. Two patients were treated with the off-the-shelf four-branched Zenith t-Branch thoracoabdominal stent-graft (Cook Medical, Bloomington, Ind). In both cases, the renal arteries (on one side in patient #1 and on both sides in patient #2, respectively) were occluded at time of index intervention. Preoperative planning included the intentional occlusion of each DB with one 7Q-MVP. Technical success was achieved in all cases and maintained at mid-term follow-up (12months and 36months, respectively). Use of the MVP appears to be feasible and effective for intentional occlusion of DB during complex endovascular aortic repair. This novel and simple technique may present some unique technical advantages, allowing precise placement of the device while avoiding extension using a bridging stent and DB cannulation with larger sheaths.

Low profile vascular plug for transarterial occlusion of patent ductus arteriosus in small dogs.

BackgroundMinimally invasive transcatheter occlusion using Amplatz canine duct occluder (ACDO) is the treatment of choice for dogs with left‐to‐right shunting patent ductus arteriosus (PDA). However, in small dogs the femoral artery diameter is often too small to accommodate the guiding catheter required for ACDO deployment.ObjectiveDescribe the effectiveness of transarterial implantation of Amplatzer Vascular Plug 4 (AVP‐4), the only self‐expandable nitinol mesh occlusion device which can be implanted through a 4 French diagnostic catheter, in small dogs with left‐to‐right shunting PDA.AnimalsSeven client‐owned dogs.MethodsDescriptive case series. Dogs with hemodynamically relevant left‐to‐right shunting PDA and a femoral artery diameter less than 2.0 mm measured preoperatively with ultrasonography were prospectively enrolled.ResultsAngiography after releasing the device showed complete immediate PDA closure in 5 dogs, where the manufacturers' recommendation were strictly followed (30%‐50% device oversizing of the ductal ampulla's diameter). Trivial residual flow on angiography in the 6th dog, whose device was slightly undersized, had resolved on echocardiography within 2 hours after placement. Marked device undersizing in the 7th dog resulted in severe residual shunting, which necessitated the addition of a coil. In this dog, the AVP‐4 embolized into the pulmonary artery within 2 weeks after placement.Conclusions and Clinical ImportanceTransarterial implantation of AVP‐4 is a safe, effective and technically easy procedure for PDA occlusion in small dogs and offers a valuable alternative to coil implantation. Accurate PDA measurement and device sizing is essential to prevent residual shunting, inadvertent device embolization, and protrusion of the device into the aorta.

Dual-balloon assisted super-selective embolisation of high flow arterial venous fistula within a transplant kidney

BackgroundIn this case report, we describe a novel application of the technique of ‘dual-balloon assisted’ cannulation and embolisation of a high flow arterial venous fistula (AVF) in transplant kidney, where attempts at standard and previously described embolisation techniques were proving difficult to achieve.Case presentationSeventy year old gentleman with renal transplant presenting with high output cardiac failure and deteriorating renal function. Angiography demonstrated high flow traumatic AV fistula within transplanted kidney, secondary to multiple biopsies. Attempts at guidewire and guiding sheath placement and stability for occlusion plug deployment were failing due to combination of very high back-flow pressures within the AVF and challenging vascular anatomy; with an aneurysmal, tortuous iliac artery as well as intra renal transplanted vessels. A combination of angioplasty and remodeling aortic balloons in the transplant artery and the host external iliac vein respectively, facilitated stabilization of guiding sheath and hence controlled delivery of an occlusion plug from the venous side of the fistula. The fistula was successfully embolised, leading to complete resolution of patient symptoms and improvement of renal function beyond his previous baseline.ConclusionsPercutaneous embolisation is an established technique to treat iatrogenic AVF in transplant kidneys. High flow pressure through an AVF, as demonstrated in this case, can cause difficulty and raise safety issues in accessing and embolising the AVF using previously described techniques. This case report describes an effective and novel application of the technique of using a second balloon in the host common iliac vein to; lower flow pressure, stabilise the guidewires during plug deployment and prevent displacement of wires and/or plug into the common iliac vein.

Modified candy-plug device for aneurysmal false lumen occlusion in chronic type B aortic dissection

Modified candy-plug device for aneurysmal false lumen occlusion in chronic type B aortic dissection

Techniques and outcomes of paravalvular leak repair after transcatheter aortic valve replacement.

To investigate the feasibility, procedural success, and outcomes of paravalvular leak (PVL) closure in patients with prior transcatheter aortic valve replacement (TAVR). PVL after TAVR is associated with adverse patient outcomes and increased mortality. Percutaneous PVL closure has emerged as a therapeutic strategy for addressing this issue, but data for transcatheter PVL repair after TAVR remains limited. This is a single center retrospective review of PVL closure after TAVR. Patients with balloon-expandable or self-expanding prostheses were included. Baseline patient demographics, procedural characteristics, complications, and clinical outcomes were reviewed. A total of 18 patients with clinically significant PVL after TAVR referred for PVL closure were identified during the study period. Procedural success resulting in successful transcatheter occluder plug delivery was 78% (14 cases). Balloon postdilatation (2/4) and valve-in-valve (2/4) were used effectively in the remaining patients after an unsuccessful PVL closure attempt. PVL grading by echocardiography decreased from moderate or severe to < moderate in 13 patients (72%). Adverse events including cardiac tamponade and acute kidney injury occurred in 1 case each. One-month all-cause mortality was 11%. In selected patients, percutaneous PVL repair following TAVR is feasible and effective for both balloon-expandable and self-expanding prostheses. Most patients undergoing PVL closure after TAVR require a single occluder plug placement for reduction in PVL to mild or less.

Distal Migration of a Vascular Occlusion Plug in an Aberrant Right Subclavian Artery Resulting in Recurrent Dysphagia Following Use in Repair of Dysphagia Lusoria

Distal Migration of a Vascular Occlusion Plug in an Aberrant Right Subclavian Artery Resulting in Recurrent Dysphagia Following Use in Repair of Dysphagia Lusoria

Results of Portosystemic Shunt Embolization in Selected Patients with Cirrhosis and Recurrent Hepatic Encephalopathy

Large portosystemic shunts (PSSs) may lead to recurrent encephalopathy in patients with cirrhosis and embolization of these shunts may improve encephalopathy. Five patients underwent balloon-occluded retrograde transvenous obliteration (BRTO) or plug-assisted retrograde transvenous obliteration (PARTO) of a large PSS at our center in last 2 years for recurrent hepatic encephalopathy (HE) at a tertiary care center at north India. Data are shown as number and mean±SD. None of these patients had Child's C cirrhosis or presence of large ascites/large varices. Five patients (all males), aged 61±7 years, underwent BRTO or PARTO for recurrent HE and presence of lienorenal (n=4) or mesocaval shunt (n=1). The etiology of cirrhosis was cryptogenic/non-alcoholic steatohepatitis in 3, and alcohol and hepatitis B in one each. All patients had Child's B cirrhosis; Child's score was 8.6±0.5, model for end-stage liver disease (MELD) score was 13.4±2.3. One patient had mild ascites; 3 patients had small esophageal varices before procedure. Sclerosants (combination of air, sodium tetradecyl sulphate, and lipiodol) were used in two patients, endovascular occlusion plugs were used in two patients, and both sclerosants and endovascular occlusion plug were used in one patient. Embolization of minor outflow veins to allow for stable deposition sclerosants in dominant shunt was done using embolization coils and glue in two patients. One patient needed 2 sessions. The pre-procedure ammonia was 127±35 which decreased to 31±17 after the shunt embolization. There was no recurrence of encephalopathy in any of these patients. One patient was lost to follow-up at 6 months; others are doing well at 6 months (n=2), 10 months (n=1) and 2 years (n=1). None of these patients developed further decompensation in the defined follow-up period. Good results can be obtained in selected patients after embolization of large PSS for recurrent HE.

The Medtronic Micro Vascular Plug™ for Vascular Embolization in Children With Congenital Heart Diseases

To describe the early multi-center, clinical experience with the Medtronic Micro Vascular Plug™ (MVP) in children with congenital heart disease (CHD) undergoing vascular embolization. The MVP is a large diameter vascular occlusion device that can be delivered through a microcatheter for embolization of abnormal blood vessels. A retrospective review of embolization procedures using the MVP in children with CHD was performed in 3-centers. Occlusion of patent ductus arteriosus using the MVP was not included. Ten children underwent attempted occlusion using the MVP. The most common indication to use the MVP was failed attempted occlusion using other embolic devices. Five, single ventricle patients (median age 3-years, median weight 14.9 kg) underwent occlusion of veno-venous collaterals following bidirectional Glenn operation. Three patients (Median age 8 years) underwent occlusion of coronary artery fistulae (CAF). Two patients (age 7 months and 1 year) underwent occlusion of large aorto-pulmonary collaterals. A 7-day-old child with a large CAF required 2 MVPs and an Amplatzer Vascular Plug (AVP-II) for complete occlusion. Occlusion of all other blood vessels was achieved using a single MVP. One MVP embolized distally in an 8-years-old child with a large CAF. There were no other procedural complications or during follow-up (median 9 months). The MVP is a new, large-diameter vascular embolization device that can be delivered through a microcatheter. It may play an important role in providing highly effective occlusion of abnormal vessels in children.

Results of Portosystemic Shunt Embolization in Selected Patients with Cirrhosis and Recurrent Hepatic Encephalopathy

Backround and Aim: Large portosystemic shunts may lead to recurrent encephalopathy in patients with cirrhosis and embolization of these shunts may improve encephalopathy. Methods: Five patients underwent balloon-occluded retrograde transvenous obliteration (BRTO) of a single large portosystemic shunt at our centre in last 2 years for recurrent hepatic encephalopathy. Data is shown as number and mean ± SD. None of these patients had Child's C cirrhosis or presence of large ascites/large esophageal varices. Results: Five patients (all males), aged 61 ± 7 years underwent BRTO for recurrent HE and presence of lienorenal (n = 4) or mesocaval shunt (n = 1). The etiology of cirrhosis was cryptogenic/NASH in 3, alcohol and hepatitis B in one each. All patients had Child's B cirrhosis; Child's score was 8.6 ± 0.5, MELD score was 13.4 ± 2.3. One patient had mild ascites; 3 patients had small esophageal varices before procedure. Sclerosant (combination of air, sodium tetradecyl sulfate and lipiodol) were used in two patients, endovascular occlusion plugs were used in two patients and both sclerosants and endovascular occlusion plug were used in one patient. Embolisation of minor outflow veins to allow for stable deposition sclerosants in dominant shunt were done using embolisation coils and glue in two patients. One patient needed 2 sessions of BRTO. None of the patients had any procedure related complication. The pre-procedure ammonia was 127 ± 35 which decreased to 31 ± 17 after the shunt embolisation. There was no recurrence of encephalopathy in any of these patients. One patient was lost to follow up at 6 months; others are doing well at 6 months (n = 2), 10 months (n = 1) and 2 years (n = 1). None of these patients developed further decompensation in the defined follow up period. Conclusion: Good results can be obtained in selected patients after embolization of a single large portosystemic shunt for recurrent hepatic encephalopathy. The authors have none to declare.

An Incidental Finding of Severe Hypoxia in an Asymptomatic Patient Caused by Pulmonary Arteriovenous Malformations

SESSION TITLE: Pulmonary Vascular Disease Cases I SESSION TYPE: Affiliate Case Report Slide PRESENTED ON: Monday, October 26, 2015 at 11:00 AM - 12:00 PM INTRODUCTION: Pulmonary arteriovenous malformations (AVMs) are a rare clinical entity, especially when found in isolation with no underlying etiology. Literature review suggest that pulmonary AVMs are symptomatic in 91% of cases, with dyspnea in 82% and cyanosis in 79% of patients. Furthermore, 70% are also associated with Osler Weber Rendu Syndrome. We report a case of severe asymptomatic hypoxia, discovered incidentally on routine pre-operative evaluation, found to have isolated multiple large pulmonary AVMs. Workup failed to show any underlying etiology. CASE PRESENTATION: The patient is a 54 year old female, with a history of COPD and severe aortic valve insufficiency, diagnosed via an echocardiogram at another facility, referred to cardiovascular surgery at our hospital. During pre-surgical evaluation, she was found to be hypoxic, with oxygen saturation in the 80%s on 2L of oxygen by nasal cannula and was admitted. Upon admission, her oxygen saturation was at 85% on a non re-breather mask. She denied any symptoms. Physical examination was unremarkable. Laboratory values showed hemoglobin of 17.3g/L and hematocrit of 48.9%. Chest X-Ray revealed a mass like density in the right lower lobe (RLL). CT scan of the thorax with contrast was negative for pulmonary embolus but 4 AVMs in RLL and 2 in right upper lobe were identified. Further questioning and workup was negative for Osler-Weber-Rendu syndrome or other underlying etiology. Resting echo showed an EF of 70% and a Bubble Echocardiogram revealed extensive right to left shunting. Bubbles entered from the pulmonary venous drainage into the left atrium consistent with AVMs. She had a pulmonary angiogram and AVMs of the RLL were embolizedx2 and an amplatzer vascular occlusion plug was deployedx2. After embolization, the patient's oxygen saturation was at 95% on 6L of oxygen. A Transesophageal Echo showed moderate aortic insufficiency and she decided to forego cardiac surgery. DISCUSSION: Studies show most cases of pulmonary AVMs have an underlying etiology and are symptomatic in 91% of patients. Our case represents a patient with large asymptomatic pulmonary AVMs with no underlying etiology. CONCLUSIONS: It shows that in patients presenting with hypoxia with no clear underlying cause, pulmonary AVMs can be considered as a cause and that pulmonary angiogram and embolization of AVMS is the cornerstone of treatment of pulmonary AVMs. Reference #1: Faughnan ME, LUI YW, Wirth JA, et al. Diffuse Pulmonary arteriovenous malformations: characteristics and prognosis. Chest 2000; 117:31 DISCLOSURE: The following authors have nothing to disclose: Asad Omar No Product/Research Disclosure Information

Amplatzer vascular plug for occlusion or flow reduction of hemodialysis arteriovenous access

Use of the Amplatzer vascular plug (AVP; St. Jude Medical Inc, St. Paul, Minn) for percutaneous occlusion of a hemodialysis arteriovenous access (AVA) is an emerging practice, and only a few reports by radiologists have been published. We report here a multidisciplinary experience of this technique not only for AVA occlusion but also for flow reduction in selected patients. This preliminary study includes a series of 20 plugs of different generations (I, II, and IV) used in 19 hemodialysis patients (two children, 17 adults). Of these, 15 AVAs were autologous fistulas located at the elbow, 4 were autologous forearm fistulas, and 1 was a brachial-basilic polytetrafluoroethylene graft. AVP deployment was through a 4F to 8F sheath, with oversizing from 30% to 50% to reduce the risk of migration. AVA occlusion (n = 14), by placing the AVP in the vein at its origin, was performed for central vein occlusion after unsuccessful percutaneous recanalization (n = 4), high flow (n = 2), hand ischemia (n = 3), successful kidney transplant (n = 1), and brachial-basilic or brachial-brachial fistula second-stage superficialization technical failure (n = 4). Vein/polytetrafluoroethylene grafts were not removed. AVA flow reduction (n = 6), by placing the AVP in the radial artery, was performed for well-tolerated high flow (n = 3) or high flow associated with distal ischemia (n = 3). All patients underwent a postoperative evaluation at 6-month intervals that included a clinical examination and duplex scan. AVA occlusion or flow reduction was successfully achieved in all patients. Ischemia persisted in one patient and a revascularization with a distal bypass was necessary. Mean follow-up was 1.2 ± 0.8 years (range, 2 months-2.9 years). No plug migration, access revascularization, or other complication was observed. The results of this short preliminary study suggest that plug insertion for occlusion or for flow reduction in a hemodialysis AVA constitutes a reasonable alternative to coil insertion or to open surgery in selected patients.

Distal False Lumen Occlusion in Aortic Dissection With a Homemade Extra-Large Vascular Plug: The Candy-Plug Technique

To report a technique to create an extra-large vascular plug for occlusion of a large distal false lumen in chronic aortic dissection. The "candy-plug" technique is demonstrated in a 58-year-old multimorbid man with a history of complicated acute type B aortic dissection and a 9-cm chronic thoracic false lumen aneurysm. The patient underwent a staged repair with a cervical debranching procedure as a first step and a thoracic endovascular aortic repair from the innominate artery to the celiac artery as a second step. To occlude the large false lumen from a distal route, a stent-graft was modified on-table with a diameter-restricting suture, giving it a wrapped candy-like shape. This plug was deployed into the false lumen, and the remaining opening was occluded with a standard vascular plug. On 3-month follow-up imaging, the thoracic false lumen aneurysm remained completely thrombosed. The candy-plug technique can facilitate complete occlusion of chronic thoracic false lumen aneurysm by prohibiting distal false lumen backflow.

O-031 Preliminary Experience with the MVP™ Device, a New Microcatheter-Deliverable Vascular Plug for Rapid Endovascular Vessel Occlusion and Flow Control

PurposeTo test the feasibility of a novel microcatheter-deliverable self-expanding vascular plug for use in endovascular flow control and vessel occlusion.Methods40 peripheral vessels in 10 canines were utilised to assess acute...

Pulmonary Embolism Risk Following Upper Extremity DVT in a Single-Center Series of 500 Consecutive Patients

aneurysm neck but a right renal artery supplied from the body of the aneurysm. Given the severity of his pulmonary disease, risk of embolization of his renal arteries, as well as difficulty of cross-clamping the aorta with the horseshoe kidney, the decision was made to perform an EVAR with preservation of his right renal artery. The left common femoral artery aneurysm was excised and replaced with a 10-mm Dacron graft and an Endurant (Medtronic, Minneapolis, Minn) main body deployed via the left common femoral artery. His iliac arteries were severely tortuous, making cannulation of the contralateral gate extremely difficult, so the gate was cannulated via left brachial access. An occlusion plug was used to occlude the gate and convert the endograft into an aortouniiliac system. The right renal artery was then serially stented with two iCAST (Atrium Medical Corp, Hudson, NH) stents, a Viabahn (W L Gore & Associates, Flagstaff, Ariz) stent, and two Endurant limb extensions into the distal common iliac artery. A femoral-femoral bypass was then performed to provide left leg perfusion (Fig). Results: Completion angiography demonstrated straight-line flow from the aorta to the right iliac limb, across the femoral-femoral bypass with perfusion of the right renal artery via retrograde filling of the left common iliac artery with no evidence of a leak. Follow-up computed tomography at 2 weeks demonstrated filling of the right renal artery and entirety of the horseshoe kidney, with no evidence of endoleak. His creatinine remained at 0.9 postoperatively. Conclusions: Patients presenting with both AAA and horseshoe kidneys are rare, reported in the literature as only 0.12% of AAAs. This patient presented with the challenging anatomy of not only a horseshoe kidney but also a perirenal AAA. Options included reimplantation or ligation of the right renal artery, but would have necessitated an open surgery or worsened renal failure in this patient. The complex aneurysm repair chosen demonstrates an alternative method, allowing for preservation of the perfusion and function of his horseshoe kidney.

Interaction of xylem and phloem during exudation and wound occlusion in Cucurbita maxima

Collection of cucurbit exudates from cut petioles has been a powerful tool for gaining knowledge on phloem sap composition without full notion of the complex exudation mechanism. Only few publications explicitly mentioned that exudates were collected from the basal side of the cut, which exudes more copiously than the apical side. This is surprising since only exudation from the apical side is supposedly driven by phloem pressure gradients. Composition of carbohydrates and pH values at both wounding sides are equal, whereas protein concentration is higher at the basal side. Apparently, exudation is far more complex than just the delivery of phloem sap. Xylem involvement is indicated by lower protein concentrations after elimination of root pressure. Moreover, dye was sucked into xylem vessels owing to relaxation of negative pressure after cutting. The lateral water efflux from the vessels increases turgor of surrounding cells including sieve elements. Simultaneously, detached parietal proteins (PP1/PP2) induce occlusion of sieve plates and cover wound surface. If root pressure is strong enough, pure xylem sap can be collected after removal of the occlusion plug at the wound surface. The present findings provide a mechanism of sap exudation in Cucurbita maxima, in which the contribution of xylem water is integrated.

Amplatzer Vascular Plug for Occlusion of Parent Artery in Carotid Blowout with Active Extravasation

Carotid blowout is a devastating complication in patients with head and neck malignancy. Various treatments including high risk surgery, carotid stenting or carotid occlusion using either coils or detachable balloons have been described. The key for any treatment is the rapidity at which it can be performed. We describe treatment of common carotid blowout secondary to neoplastic infiltration using four Amplatzer vascular plugs deployed in less than ten minutes.

Amplatzer vascular plug closure of a subclavian arteriovenous fistula associated with implantable cardioverter‐defibrillator implantation

Subclavian arteriovenous fistula (AVF) is a rare complication of implantable cardioverter-defibrillator (ICD) implantation. This report illustrates the case of a subclavian AVF after ICD implantation in a patient with nonischemic cardiomyopathy and the successful closure of this AVF using an Amplatzer vascular occlusion plug. Given the increasing number of ICD implantations, physicians should be made aware of this uncommon complication. In addition, as more percutaneous endovascular techniques are developed to treat peripheral vascular and structural heart disease, iatrogenic AVFs may occur more frequently. The Amplatzer vascular plug should be considered as a potential treatment strategy for AVFs alongside other endovascular and surgical techniques.

Midterm outcome of endovascular repair of ruptured isolated iliac artery aneurysms

This study analyzed the clinical and morphologic outcomes of endovascular treatment of ruptured isolated iliac artery aneurysms (RIIAA) at midterm follow-up. Eleven patients with RIIAA (1 woman, 10 men; mean age, 73 years; mean IIAA diameter, 69.1 mm) were identified in a single-center database of patients who underwent endovascular aortoiliac aneurysm repair between April 2001 and December 2009. Devices inserted included 9 leg endografts in 7 patients (Excluder, n=7; Zenith, n=2), 3 bifurcated stent grafts in 3 patients (Excluder), and 1 aortouniiliac stent graft in 1 patient (Zenith). Endovascular occlusion of the internal iliac artery or its branches was performed in all cases by coils (n=10) or Amplatzer occluder plug (n=1). Immediately after endovascular aneurysm exclusion, a computed tomography (CT) angiography was obtained in nine patients. Except for this adjunct postimplantation CT scanning, the imaging follow-up was the same as for nonruptured aortoiliac aneurysms at 3, 6, and 12 months and annually thereafter. Mean delay from hospital admission to intervention was 78.5 minutes. Mean intervention time was 150 minutes. The assisted primary technical success rate was 100%. Median lengths of stay were 2 days in the intensive care unit and 13 days in the hospital. Abdominal compartment syndrome developed in three patients who received open abdomen treatment. The 30-day mortality was 18%. The mean follow-up was 23 months (range, 0-69 months). There were no late deaths during the follow-up. There was no need for late surgical conversion. Aneurysm sac shrinkage (defined as >5 mm) was recorded in five patients, whereas the sac diameter remained stable in four. There was no patient with aneurysm sac growth. Additional stent graft insertion as the only secondary intervention for a type Ib leak was performed. Type II endoleaks (primary and secondary) were found in 36% and secondary Ib in 9% of the patients. Emergency stent grafting of RIIAA is feasible and safe with good midterm outcome.

Left atrial appendage-occluding devices for stroke prevention in patients with nonvalvular atrial fibrillation

Atrial fibrillation is associated with a fivefold increased risk for stroke, mostly secondary to thromboembolic events. Anticoagulation with a vitamin K antagonist is the standard medical therapy for these patients but is difficult to maintain within the therapeutic range and requires frequent monitoring and dose adjustments. Approximately 90% of thromboembolism occurs in the left atrial appendage (LAA) in patients with nonvalvular atrial fibrillation. Occlusion of flow into the LAA may prevent thrombus formation in the appendage and, hence, reduction of stroke. Recently, several percutaneous transcatheter techniques of LAA exclusion using the Percutaneous Left Atrial Appendage Transcatheter Occlusion device, the WATCHMAN® device, and AMPLATZER® septal occluder and cardiac plug have been employed, with encouraging results. Occlusion of the LAA may be an alternative to vitamin K antagonist therapy for selected patients.

Outcomes of Amplatzer Vascular Plugs for Occlusion of Internal Iliacs during Aortoiliac Aneurysm Stent Grafting

We report on the outcomes of the Amplatzer vascular plug (AVP) for occlusion of the internal iliac artery (IIA) during stent grafting of aortoiliac and isolated common iliac artery aneurysms. We retrospectively reviewed 10 patients treated concomitantly with a single AVP in the IIA and endografting of the degenerative aneurysmal segment. Imaging review included pre- and postdeployment conventional angiography as well as pre- and postprocedure contrast-enhanced computed tomography (CT). Furthermore, subjective pre- and postprocedure exercise tolerance was also assessed, with specific attention directed toward the presence or absence of buttock claudication. Placement of the AVP precisely in the main trunk of the IIA was achieved in all cases using a standard up-and-over approach while maintaining patency of the distal trunk and both divisional IIA branches. No type II endoleaks through the AVP were identified intraoperatively or on follow-up CT imaging. Buttock claudication was absent in all but one patient, whose symptoms resolved at 6 weeks. The AVP device can be used as an alternative to coils to occlude the IIA at the time of stent graft repair of aortoiliac aneurysms. The deployment accuracy of this device allows for consistent preservation of the IIA divisional bifurcation and, thus, may allow for preservation of important pelvic collateral flow.