Outcomes of Parenchymal Tract Embolization Using PTFE-Coated Plugs at One Institution.

Tuesday, March 7, 2023

3:18 PM – 3:27 PM

Location: Phoenix Convention Center, 221C

Presenting Author(s)

Timothy J. Breider, BS

Medical Student
Rush University Medical Center

Disclosure information not submitted.

Author/Co-author(s)

Ashley M. Barry, MS (she/her/hers)

Medical Student
Rush University Medical Center
DT

David Tabriz, MD, RPVI

Assistant Professor of Radiology
Rush University
RR

Rehan Riaz, MD

Assistant Professor of Radiology
Rush University Medical Center
KM

Kumar Madassery, MD

Associate Professor, Vascular and Interventional Radiology
Rush University Medical Center, Rush Oak Park
Jordan Tasse, MD

Associate Professor, Vascular and Interventional Radiology
Rush University Medical Center
UT

Ulku C. Turba, MD FSIR

Professor, Vascular and Interventional Radiology
RUSH University Medical Center
Bulent Arslan, MD FSIR

Professor and Chair, Vascular and Interventional Service Line
Rush University Medical Center

Disclosure(s):

Ashley M. Barry, MS: No financial relationships to disclose

Kumar Madassery, MD: Abbott Vascular: Consultant (Ongoing); Cook Mediical: Consultant (Ongoing); Koninklijke Philips: Consultant (Ongoing); PENUMBRA INC: Consultant (Ongoing)

Jordan Tasse, MD: No financial relationships to disclose

Ulku C. Turba, MD FSIR: No financial relationships to disclose

Bulent Arslan, MD FSIR: Angiodynamics Inc: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing); BD Bard: Consultant (Ongoing), Speaking and Teaching (Ongoing); Blackswan Vascular Inc: Consultant (Ongoing), Ownership Interest (Ongoing), Speaking and Teaching (Ongoing); Cook Inc: Consultant (Ongoing), Speaking and Teaching (Ongoing); Medtronic Inc: Consultant (Ongoing), Speaking and Teaching (Ongoing); Penumbra: Speaking and Teaching (Ongoing)

Purpose: Percutaneous access is necessary for many procedures involving the portal venous system. However, if the tract created through the sinusoidal parenchyma of the liver or spleen is not adequately embolized, it can result in a potentially life-threatening hemorrhage. Historically, gel foam, glue, and coils have been options for closure of the parenchymal tract. Newer PTFE-coated plugs allow for quick, easy, mechanical occlusion that does not rely upon thrombus formation. The aim of this study is to analyze rates of technical success and for prevention of bleeding using PTFE-coated plug tract closure following percutaneous transhepatic and transplenic interventions at one institution.

Materials and Methods: Electronic medical records were reviewed to identify cases using percutaneous access through the liver or spleen. Procedures where the parenchyma was embolized using a PTFE-coated plug (MVP Micro Vascular Plug, Medtronic, Dublin, Ireland) were further selected. Procedure reports and clinical notes from 3 to 30 days post-procedure were reviewed to identify demographics, associated procedures, embolization agents used, rates of technical success, and incidence of hemorrhage.

Results: In total, 47 procedures in 42 patients (24M, 18F) were identified as being performed via percutaneous access that used a PTFE-coated plug to occlude the tract. Transhepatic access was used in 42 cases and transplenic in 5. Types of procedures included venograms, embolizations, stent placements, thrombolysis, and TIPS placements. Technical success was 98% with one instance of an unsuccessful plug deployment. In five cases a second plug was necessary for embolization; one additional case needed three plugs. One case used a coil in addition to two plugs. In 39 cases, gel foam was used as an adjunctive agent.

In all cases, no evidence of hemorrhage was detected via computed tomography (CT) at 72 hours post-procedure. Additionally, no other evidence of hemorrhage was identified within 30 days post-procedure. One patient died within 72 hours and 6 patients had died by 30-day follow-up, all due to pre-existing underlying disease.

Conclusion: The use of PTFE-coated plugs is a technically feasible and safe option to embolize percutaneous tracts through the liver and spleen. This study demonstrated that their use has resulted in no acute post-procedural hemorrhage or hemorrhage within 30 days at one institution.