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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: [email protected]
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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

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