Occlusion of Arteriovenous Fistulas of In-Situ Saphenous Vein Bypass Grafts Using the Amplatzer Vascular Plug 4: Initial Experience

We examined the safety and efficacy of vessel occlusion of the Amplatzer Vascular Plug 4 (AVP-4) in patients with arteriovenous fistulas after in-situ saphenous vein bypass grafts. We treated 18 fistulas of seven patients (four women, mean ± standard deviation age 76 ± 7 years, range 63–88 years). All fistulas were detected within 14 days after surgery. Initial diagnosis and follow-up was established by sonography. We measured the diameter of the feeding vessel and the time of vessel occlusion after plug deployment. Additionally, we recorded procedure time and the dose area product. Additional interventional procedures were necessary in three patients. We successfully used 19 AVP-4 for occlusion of all fistulas without thromboembolic complications. There was no need for recapturing the device, and we did not observe dislocation. Mean occlusion time was 9.6 min (range 5–22 min). Mean diameter of the feeding vessels was 3.5 mm (range 2.6–5.1 mm). Plug sizes ranged from 4–8 mm (mean 5.5 mm) resulting in an oversizing of 33–88%. Mean procedure time for patients with and without additional intervention was 91 ± 38 min and 35 ± 18 min, respectively. Mean dose area product was 11,790 cGy/cm² (range 1,850–23,500 cGy/cm²). Permanent occlusion of the fistulas was confirmed by ultrasound after a mean follow-up of 4 months (1–6 months). Occlusion of arteriovenous fistulas with an AVP-4 seems to be effective and safe in patients with in-situ saphenous vein bypass grafts. The AVP-4 is well suited for this purpose because of the appropriate diameter of the feeding vessels.