Embolic Agents: Vascular Plugs

History of Vascular Plugs

The advent of vascular plugs for peripheral embolization dates to the early part of this century. To address the deficiencies of coils, the Food and Drug Administration (FDA) approved the first vascular plug, the Amplatzer vascular plug or AVP (Abbott Laboratories, Illinois), in 2004 for peripheral vascular embolization.[1] The original AVP, a derivative of the Amplatzer septal occluder and Amplatzer duct occluder, was first successfully utilized in the cardiac setting for percutaneous closure of aortopulmonary collaterals in a 4.5-month-old infant.[2] Two years later, interventionalists extended the use of the AVP to treat peripheral vascular malformations in patients with congenital heart disease.[3] The following year, the AVPII was released, which was capable of occluding vessels up to 17 mm in diameter, allowing for expanded clinical applications. As popularity and demand increased for the AVP models, advancements in vascular plug technology followed suit over the past 15 years. Today, vascular plugs have many unique attributes, including various shapes and constructs, microcatheter applications, membranes, and deployment methods ([Tables 1] and [2]).

Table 1 Advantages, disadvantages, and cost of main plug components

	Advantages	Disadvantages	Cost	Market examples
Material
Nitinol	Exhibits shape memory and superelasticity. Most common and readily available plug material on market	Shown to have variable rates of recanalization. Not shown to have significant intradevice collagenous healing postembolization	$$	AVP, MVP, Caterpillar, AZUR
Polyurethane	Responds to more physical and chemical triggers than nitinol as a shape memory polymer. Shown to promote stable clot formation long term with reduce rates of recanalization compared with coils and nitinol plugs. Less expensive than nitinol plugs	Relatively new in the market with limited microcatheter applications. Current models are on the higher side of the spectrum in regard to device length	$	IMPEDE
Membrane
PTFE	Provides immediate mechanical blockage that is not dependent on thrombogenesis	Slightly adds to the overall cost of the device	$	MVP, Caterpillar, IMPEDE, AZUR

Table 2 Advantages, disadvantages, and cost of plug deployment methods

	Advantages	Disadvantages	Cost	Market examples
Plug deployment method
Mechanical: Screw release	Most common and readily available modality. Most cost efficacious	Can cause unnecessary strain and torque on nearby vessels upon deployment	$	AVP, MVP, Caterpillar
Mechanical: Button release	Easier and smoother deployment technique than screw release mechanism	Limited current options and research in regard to treatable vessel ranges. Slightly increases the overall price of a plug	$$	LOBO, AZUR
Electrolytic	Most precise delivery method	Most expensive deployment technique. Takes time for setup Also, not readily available in many current models	$$$	MVP, AZUR

Publication History

Article published online:
20 December 2022

• References

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