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Transcatheter closure of the arterial duct without arterial access
Fiona E Willcoxson1, Sangeetha Viswanathan, John D R Thomson
1Department of Congenital Cardiology, Leeds General Infirmary, Leeds, UK.
Insights
Transcatheter closure of the arterial duct is safe and effective using only venous access. This approach avoids femoral arterial catheterization complications, making it suitable for most patients.
Area of Science:
- Cardiovascular Interventions
- Pediatric Cardiology
- Medical Device Technology
Background:
- Patent arterial ducts (PAD) are commonly treated with percutaneous closure.
- Standard practice involves femoral arterial catheterization for device implantation and imaging.
- Femoral catheterization carries risks, necessitating alternatives when possible.
Purpose of the Study:
- To assess the safety and efficacy of transcatheter arterial duct occlusion without femoral arterial catheterization.
- To evaluate outcomes using venous access alone for duct closure procedures.
Main Methods:
- A retrospective review of 389 consecutive arterial duct occlusions (1994-2004).
- Procedures utilized Cook detachable coils (n=288) or Amplatzer duct occluder (n=101).
- Data collected on procedural success, device displacement, re-intervention, and patient follow-up.
Main Results:
- Venous access alone enabled occlusion in 75% of coil cases and 82% of Amplatzer cases.
- Complete occlusion was achieved in 98% of coil patients and 100% of Amplatzer patients at follow-up.
- Complications included device embolization, hemolysis, residual shunting, and rare pulmonary artery stenosis.
Conclusions:
- Arterial catheterization is largely unnecessary for arterial duct occlusion.
- Venous catheterization alone is a safe and effective alternative.
- This approach does not increase device-related complication risks.
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.
