PMC6047098_01
A) Celiac arteriography reveals the common hepatic artery (CHA) with a maximum diameter of 4.2 mm. B) A 6-mm Amplatzer Vascular Plug (AVP) II is deployed at the mid-portion of the CHA
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Celiac arteriography revealed CHA with a maximum diameter of 4.2 mm (Fig. 1A); a 4-F catheter was advanced to the gastroduodenal artery. Ansel; Cook Medical, Bloomington, Indiana) was advanced to the CHA along with a 4-F catheter, and a 6-mm AVP II was deployed at the mid-portion of the CHA (Fig. 1B). Although the AVP was completely expanded, it did not move, even if force was exerted on the delivery cable.
A) The Amplatzer Vascular Plug (AVP) migrated to the proximal portion of the proper hepatic artery after detachment. B and C) Although retrieval of the migrated AVP using a goose neck snare was attempted, it was impossible to retrieve it into a 5-F guiding catheter
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AVP migrated to the proximal portion of the proper hepatic artery approximately 30 seconds after detachment (Fig. 2A). Although migrated AVP retrieval using a goose neck snare (Amplatz GooseNeck Snare; Medtronic, Minneapolis, Minnesota) was attempted, it was impossible to retrieve it into the 5-F guiding sheath because the AVP delivery screw became stuck within the sheath edge (Fig. 2B-C).
A) A 6-mm Amplatzer Vascular Plug (AVP) (arrow head) was delivered to the splenic artery and a 10-mm AVP II (arrow) was redeployed at the proximal portion of the common hepatic artery (CHA). B) Superior mesenteric arteriography reveals good blood flow to the intrahepatic artery via the pancreatic arterial arcade
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Finally, a 10-mm AVP II was redeployed at the proximal portion of the CHA, and complete occlusion was achieved (Fig. 3A-B).