Hostname: page-component-76fb5796d-25wd4 Total loading time: 0 Render date: 2024-04-25T16:47:11.365Z Has data issue: false hasContentIssue false
  • English
  • Français

Transcatheter closure of the arterial duct without arterial access

Published online by Cambridge University Press:  16 November 2009

Fiona E Willcoxson ,
Sangeetha Viswanathan ,
John D.R. Thomson  and
John L. Gibbs
Fiona E Willcoxson*
Affiliation:
Department of Congenital Cardiology, Leeds General Infirmary, Leeds, UK
Sangeetha Viswanathan
Affiliation:
Department of Congenital Cardiology, Leeds General Infirmary, Leeds, UK
John D.R. Thomson
Affiliation:
Department of Congenital Cardiology, Leeds General Infirmary, Leeds, UK
John L. Gibbs
Affiliation:
Department of Congenital Cardiology, Leeds General Infirmary, Leeds, UK
*
Correspondence to. Dr Fiona E. Willcoxson, Department of Congenital Cardiology, E floor Jubilee Wing, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK. Tel: 07900 223740; Fax: 0113 3925750; E-mail: fiona.willcoxson@btopenworld.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To evaluate the safety and efficacy of transcatheter occlusion of the arterial duct without femoral arterial catheterization.

Background

Patent arterial ducts have been closed percutaneously since the 1960s. It remains standard practice to use arterial access for aortography before, during, and after implantation of the device. Femoral arterial catheterisation has well recognised complications, and should be avoided unless absolutely necessary.

Methods

We reviewed prospectively collected data relating to 389 occlusions of the arterial duct performed consecutively between 1994 and 2004. We inserted Cook detachable coils in 288 instances using the Amplatzer duct occluder in the remaining 101. Information was obtained regarding procedural success, displacement of the device, and re-intervention. We have followed out patients for a median of 1.15 years in those closed with the Amplatzer device, and 1.09 years in those closed with a coil.

Results

In the patients in whom we used coils, occlusion was possible in 75% using venous access alone. We reintervened in 25 patients, because of embolisation of the device in 6, haemolysis in 5, and residual shunting in 14. On follow-up, complete occlusion had been achieved in 98%. We found trivial stenosis of the left pulmonary artery in 3 patients. When using the Amplatzer device, closure using venous access alone was achieved in 82%, and 2 patients required reintervention because of embolisation of the device. Complete occlusion had been achieved in all patients as judged by follow-up at 1 year, and 2 patients had trivial stenosis of the left pulmonary artery.

Conclusion

Arterial catheterisation is unnecessary in the great majority of patients undergoing occlusion of the arterial duct. Use of venous catheterisation alone is safe, and does not appear to increase the risk of device-related complications.

Keywords

Patent ductus arteriosusinterventional closurevascular access
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 1 , February 2010 , pp. 39 - 43
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Porstmann, W, Wierny, L, Warnke, H. Closure of the persistent ductus arteriosus without thoracotomy. Ger Med Mon 1967; 12: 259–261.Google ScholarPubMed
2.Transcatheter occlusion of persistent arterial duct. Report of the European Registry. Lancet 1992; 340: 1062–1066.CrossRefGoogle Scholar
3.Verin, VE, Saveliev, SV, Kolody, SM, Prokubovski, VI. Results of transcatheter closure of the patent ductus arteriosus with the Botallooccluder. J Am Coll Cardiol 1993; 22: 1509–1514.CrossRefGoogle ScholarPubMed
4.Uzun, O, Dickinson, D, Parsons, J, Gibbs, JL. Residual and recurrent shunts after implantation of Cook detachable duct occlusion coils. Heart 1998; 79: 220–222.CrossRefGoogle ScholarPubMed
5.Masura, J, Walsh, KP, Thanopoulous, B, et al. Catheter closure of moderate to large sized patent ductus arteriosus using the new Amplatzer duct occluder: immediate and short-term results. J Am Coll Cardiol 1998; 31: 878–882.CrossRefGoogle ScholarPubMed
6.Kulkarni, S, Naidu, R. Vascular ultrasound imaging to study immediate post catheterization vascular complications in children. Catheter Cardiovasc Interv 2006; 68 (3): 450–455.CrossRefGoogle ScholarPubMed
7.Vitiello, R, McCrindle, BW, Nykanen, D, Freedom, RM, Benson, LN. Complications associated with pediatric catheterization. J Am Coll Cardiol 1998; 32 (5): 1433–1440.CrossRefGoogle Scholar
8.Lin, PH, Dodson, TF, Bush, RL, et al. Surgical intervention for complications caused by femoral artery catheterisation in pediatric patients. J Vasc Surg 2001; 33: 1071–1078.CrossRefGoogle Scholar
9.Chaikof, EL, Dodson, TF, Salam, AA, Lumsden, AB, IIISmith, RB. Acute arterial thrombosis in the very young. J Vasc Surg 1992; 16: 428–435.CrossRefGoogle ScholarPubMed
10.Taylor, LM, Troutman, R, Feliciano, P, Menashe, V, Sunderland, C, Porter, JM. Late complications after femoral artery catheterisation in children less than five years of age. J Vasc Surg 1990; 11: 297–304.CrossRefGoogle ScholarPubMed
11.Macnicol, MF, Anagnostopoulos, J. Arrest of the growth plate after arterial cannulation in infancy. J Bone Joint Surg Br 2000; 82 (2): 172–175.CrossRefGoogle ScholarPubMed
12.Balaguru, D, Dilawar, M, Ruff, P, Radtke, WAK. Early and late results of thrombolytics therapy using tissue-type plasminogen activator to restore arterial pulse after cardiac catheterisation in infants and small children. Am J Card 2003; 91: 908–910.CrossRefGoogle ScholarPubMed
13.Magee, AG, Huggon, IC, Seed, PT, Qureshi, SA, Tynan, M, on behalf of the AEPC. Transcatheter coil occlusion of the arterial duct. Eur Heart J 2001; 22: 1817–1821.CrossRefGoogle ScholarPubMed
14.Tzifa, A, Tulloh, R, Rosenthal, . Spontaneous spasm of the arterial duct: a pitfall for transcatheter occlusion. Eur Heart J 2005; 91: 31.Google ScholarPubMed
15.Rothman, A. Arterial complications of interventional cardiac catheterisation in patients with congenital heart disease. Circulation 1990; 82: 1868–1871.CrossRefGoogle ScholarPubMed
16.Thanopoulos, BD, Hakim, FA, Hiari, A, et al. Further experience with transcatheter closure of the patent ductus arteriosus using the Amplatz duct occluder. J Am Coll Cardiol 2003; 35: 1016–1021.CrossRefGoogle Scholar
17.Galal, O. Advantages and disadvantages of coils for transcatheter closure of patent ductus arteriosus. J Interv Cardiol 2003; 16: 157–163.CrossRefGoogle ScholarPubMed
18.Pass, RH, Hijazi, Z, Hsu, DT, Lewis, V, Hellenbrand, WE. Multicenter USA Amplatzer patent ductus arteriosus occlusion device trial. J Am Coll Cardiol 2004; 44: 513–519.CrossRefGoogle ScholarPubMed