137 - Plug Assisted Rectal and Stomal Variceal Embolization using the MVP Microvascular Plug System
Scott Nowakowski, MD – Director of Operations, Vascular and Interventional Radiology, Icahn School of Medicine at Mount Sinai; Vivian Bishay, MD – Assistant Professor of Radiology, Vascular and Interventional Radiology, Icahn School of Medicine at Mount Sinai; Kirema Garcia-Reyes, MD – Assistant Professor of Radiology, Vascular and Interventional Radiology, Icahn School of Medicine at Mount Sinai; Dan Shilo, MD – Assistant Professor of Radiology, Vascular and Interventional Radiology, Icahn School of Medicine at Mount Sinai; Edward Kim, MD – Assistant Professor of Radiology and Surgery, Vascular and Interventional Radiology, Icahn School of Medicine at Mount Sinai; Aaron Fischman, MD FSIR FCIRSE FSVM – Professor of Radiology, Urology and Surgery, Vascular and Interventional Radiology, Icahn School of Medicine at Mount Sinai; Robert Lookstein, MD MHCDL FSIR FAHA FSVM – Professor of Radiology and Surgery, Executive Vice Chairman, Vascular and Interventional Radiology, Icahn School of Medicine at Mount Sinai; Rahul Patel, MD – Assistant Professor of Radiology and Surgery, Vascular and Interventional Radiology, Icahn School of Medicine at Mount Sinai
Purpose: To evaluate the clinical safety and effectiveness of using the MVP microvascular plug system (Medtronic Inc.) and sodium tetradecyl sulfate (STS) foam-assisted antegrade transvenous obliteration (PATO) for the treatment of bleeding rectal and stomal varices (RV, SV).
Material and Methods: A single center retrospective review from January to December 2021 of all PATO cases done to treat rectal or stomal variceal bleeding at one academic institution. All cases using the MVP microvascular plug were evaluated. Pre-procedural data and procedural details including demographic information, MELD scores, and fluoroscopy time were collected. Post-procedural outcomes including technical success, target site rebleeding, and complications were also assessed.
Results: Five patients (4 male) ages 10 to 76 were identified all of whom had pre-procedural imaging demonstrating either stomal (2) or rectal variceal bleeding. Average pre-procedural MELD was 14. Patients underwent PATO with a single MVP-5Q, and STS foam used as the sclerosant agent, allowing the procedure to be conducted entirely through a single 4F diagnostic catheter without having to place an occlusion balloon or trapping a second microcatheter. Technical success was achieved in all 5 patients, with no access site or procedure-related complications. There was no clinical evidence of target site bleeding within 30 days of embolization. Average fluoroscopy time for the procedure was 10.78 minutes, with a median of 7 minutes. One case was performed as an adjunct to a TIPS was a statistical outlier, with 25.9 minutes of fluoro time.
Conclusions: Microvascular plug-assisted STS foam sclerosis is a safe and clinically effective for treatment of rectal and stomal variceal . This technique allows for complete sclerosis of varices using a single plug without the need for balloon occlusion or trapping of a second microcatheter.