Ureteric Embolization for Lower Urinary Tract Fistulae: Use of Two Amplatzer Vascular Plugs and N-Butyl Cyanoacrylate Employing the “Sandwich” Technique

Purpose This study describes and evaluated the effectiveness of occluding distal ureters in the clinical setting of urinary vaginal (vesicovaginal or enterovesicovaginal) fistulae utilizing a new technique which combines Amplatzer vascular plugs and N -butyl cyanoacrylate. Materials This is a retros...

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Bibliographic Details
Published in:Cardiovascular and interventional radiology 2013-08, Vol.36 (4), p.1068-1072
Main Authors: Saad, Wael E. A., Kalagher, S., Turba, U. C., Sabri, S. S., Park, A.-W., Stone, J., Angle, J. F., Matsumoto, A. H.
Format: Article
Language:English
Subjects:
Adult
Aged
Cardiology
Clinical Investigation
CLOSURES
Cohort Studies
EMBOLI
Embolization, Therapeutic - methods
Enbucrilate - therapeutic use
Female
FISTULAE
Follow-Up Studies
Humans
Imaging
Medicine
Medicine & Public Health
Middle Aged
Nuclear Medicine
PATIENTS
RADIOLOGY
RADIOLOGY AND NUCLEAR MEDICINE
Retrospective Studies
Risk Assessment
Septal Occluder Device
SYMPTOMS
Treatment Outcome
Ultrasound
Ureteral Diseases - therapy
URETERS
Urinary Bladder Fistula - diagnosis
Urinary Bladder Fistula - therapy
Urinary Catheterization - instrumentation
Urinary Catheterization - methods
Vesicovaginal Fistula - diagnosis
Vesicovaginal Fistula - therapy
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Summary:Purpose This study describes and evaluated the effectiveness of occluding distal ureters in the clinical setting of urinary vaginal (vesicovaginal or enterovesicovaginal) fistulae utilizing a new technique which combines Amplatzer vascular plugs and N -butyl cyanoacrylate. Materials This is a retrospective study (January 2007–December 2010) of patients with urinary-vaginal fistulae undergoing distal ureter embolization utilizing an Amplatzer- N -butyl cyanoacrylate-Amplatzer sandwich technique. An 8–12–mm type-I or type-II Amplatzer vascular plug was delivered using the sheath and deployed in the ureter distal to the pelvic brim. Instillation of 0.8–1.5 cc of N -butyl cyanoacrylate into ureter proximal to the Amplatzer plug was performed. This was followed by another set of 8–12-mm type-I or type-II Amplatzer vascular plugs in a technique referred to as the “sandwich technique.” Results Five ureters in three patients were occluded utilizing the above-described technique during the 4-year study period. Mean maximum size Amplatzer used per ureter was 10.8 mm (range, 8–12). One ureter required three Amplatzer plugs and the rest required two. Two patients (3 ureters) were clinically successful with complete resolution of symptoms in 36–48 h. The third patient (2 ureters) was partly successful and required a second Amplatzer- N -butyl cyanoacrylate sandwich technique embolization. The mean clinical follow-up was 11.3 months (range, 1.7–29.2). Conclusions The Amplatzer- N -butyl cyanoacrylate-Amplatzer sandwich technique for occluding the distal ureter is safe and effective with a quick (probably due to the N -butyl cyanoacrylate) and durable (probably due to the Amplatzer plugs) clinical response.
ISSN:0174-1551
1432-086X
DOI:10.1007/s00270-012-0510-1