TECHNICAL NOTE Advantages and Disadvantages of the Amplatzer Vascular Plug IV in Visceral Embolization: Report of 50 Placements Maciej Pech • Konrad Mohnike • Gero Wieners • Ricarda Seidensticker • Max Seidensticker • Adam Zapasnik • Jens Ricke • Oliver Dudeck Received: 7 August 2010 / Accepted: 10 December 2010 / Published online: 24 March 2011 Ó Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2011 Abstract Purpose We describe our initial clinical experience in artificial embolization with the Amplatzer Vascular Plug IV (VP IV), a further development of the Vascular Plug family already in routine use. Methods Results from 50 embolization procedures con- ducted with the VP IV in 44 patients are summarized. Results All 50 embolizations were successful, although two required the technique to be modified because of problems with jamming of the screw thread and thus with disconnection of the plug. This was associated with large branching angles. Conclusions With experience, the VP IV can be used safely and effectively, and it expands the spectrum of pos- sible embolizations in interventional radiology. Its greatest disadvantage is its relatively poor positional controllability. Keywords Arterial embolization Á Vascular plug Á Interventional radiology Introduction During recent years, the Amplatzer Vascular Plug family has been documented as offering an efficient and readily controllable alternative to the classical pushable coils for artificial embolization in interventional radiology [1–4]. Unlike the larger Vascular Plug II [4], the Vascular Plug IV (VP IV) can be placed by using standard narrow- lumen catheters (inside diameter 0.038 00 ), which extends the range of possible applications of the plug technique in endovascular therapy. The VP IV has a double-cone shape and is mounted on a fixed-core wire guide with a 20-cm floppy distal tip, combined with a new loader system. It can be used for expansion up to 8 mm (compared with 22 mm for the VP II). This report summarizes our initial clinical experience with the VP IV and the advantages and disad- vantages that we encountered, based on our first 50 implantation procedures. Materials and Methods A total of 50 embolization procedures were performed with the VP IV (AGA Medical Corp., Plymouth, MN), in 44 patients (18 women and 26 men; age range, 39–72 years) between July 2009 and March 2010. These included 32 embolizations of the gastroduodenal artery (GDA), 3 of the right gastric artery (RGA), and 1 of the cystic artery (in preparation for selective internal radiotherapy), 8 of the splenic artery (in 3 aneurysm cases), 3 of the left hepatic artery (port system for hepatic arterial infusion, Michels variants II and V), and 3 of the inferior mesenteric artery (for prevention of endoleak before endovascular aortic repair). In all cases, plugs were chosen in preference to coils, to ensure exact placement during embolization and to minimize the risk of device migration. The decision to embolize by inserting a VP IV was taken once a stable position in the target vessel had been reached by initial probing with a hydrophilically coated wire (0.035 00 ; Terumo, Leuven, Belgium). Catheterization was initially performed with a 0.038 00 catheter (4F, C2 Tempo; Cordis, Bridgewater, NJ). If the wire appeared to M. Pech (&) Á K. Mohnike Á G. Wieners Á R. Seidensticker Á M. Seidensticker Á A. Zapasnik Á J. Ricke Á O. Dudeck Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany e-mail: maciej.pech@med.ovgu.de 123 Cardiovasc Intervent Radiol (2011) 34:1069–1073 DOI 10.1007/s00270-011-0150-x