Preloading Coil in Plug Technique for Internal Iliac Artery Embolization During Endovascular Abdominal Aortic Aneurysm R
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LETTER TO THE EDITOR
ARTERIAL INTERVENTIONS
Preloading Coil in Plug Technique for Internal Iliac Artery Embolization During Endovascular Abdominal Aortic Aneurysm Repair Takaaki Maruhashi1,3 • Hiroshi Nishimaki1 • Yukihisa Ogawa2 • Kiyoshi Chiba1 Akiyuki Kotoku2 • Takeshi Miyairi1
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Received: 5 March 2020 / Accepted: 13 September 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
To the Editor, Internal iliac artery (IIA) embolization during endovascular abdominal aneurysm repair (EVAR) is frequently added for short distal sealing zone or combined common iliac artery aneurysm. However, short-segment embolization of IIA at a more proximal site is ideal to reduce complications, including buttock claudication [1] and type 2 endoleaks [2]. Completing this ideal embolization using only metal coils is difficult because of packing coil migration risk in high-flow situations. Amplatzer Vascular Plug 1 (AVP1: Abbott Vascular, Redwood City, CA, USA) has facilitated performance of short-segment embolization, but long-term recanalization has been reported [3, 4]. Recently, Katada et al. [5] reported a new embolization technique of filling the metallic coils into AVP1 to solve
& Takaaki Maruhashi [email protected] 1
Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
2
Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
3
Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0375, Japan
these problems. However, the microcatheter must be passed through the AVP mesh after deployment. If the microcatheter cannot be inserted into the AVP, adding it to the proximal side of the deployed AVP is extremely difficult, since there is already an insufficient space for coil embolization on the proximal side. Additionally, because the microcatheter can pass through any part of the AVP mesh, the microcatheter becomes more unstable the farther it is from the center, and the microcatheter tip may slip outside the AVP during coil packing. Thus, we devised a new technique—preloading coil in plug (p-CIP)—an improved method of the original technique. In the p-CIP technique, the microcatheter is penetrated into the vascular plug in advance as preparation, and both of them are inserted into the target vessels in this state. We used AVP1 with a size [10–20% of that of the embolized IIA diameter, 2.2-Fr microcatheter with a straight tip, and 0.016-inch micro-guidewire for our case. After plug deployment to target vessels, the microcatheter tip was pulled back into the plug. Moreover, detachable coils were used to fill the plug until the antegrade IIA blood flow had disappeared from the guiding sheath during angiography. The first coil used to fill the AVP was the detachable coil (AZUR18: Terumo, Tokyo, Japan) with a -2 mm diameter from the AVP siz
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