Endovascular treatment of a superficial femoral artery aneurysm using an Amplatzer Vascular Plug.

We read with great interest a series of recently published articles in Diagnostic and Interventional Radiology concerning the range of Amplatzer® Vascular Plugs (AVPs, AGA Medical Corp., Golden Valley, Minnesota, USA) and their increasing applications (1–3). We would like to add our experience with choosing an AVP for the treatment of a rare superficial femoral artery (SFA) aneurysm and raise some points about selecting among the AVP 1, AVP 2, and AVP 4 devices. An 80-year-old male with a right femoro-popliteal bypass graft presented with pain in his right thigh with a pulsatile mass lesion. A computed tomography angiogram demonstrated a 3 cm degenerative aneurysm of the native right SFA, and he was referred to the Interventional Radiology Department for embolization. A 65 cm cross-over sheath was inserted. Selective angiography was performed with a 20° right anterior oblique projection to unfold the profunda, graft origin, and native SFA (Fig. 1a). The native SFA was accessed using a 100 cm 4 F catheter, and angiography was performed to measure the inflow vessel and to check for significant outflow vessels (Fig. 1b). The distal SFA was shown to be patent, so two 0.035 inch coils were used to embolize the “back door”. The 6 F sheath was advanced into the proximal neck of the aneurysm. The AVP was oversized by 30%, and a 16 mm AVP 2 was selected. After deployment, the position was deemed satisfactory, and the plug was released. A post-