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.