Comparison of isolated venous approach with the standard approach in children undergoing patent ductus arteriosus device closure
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Lipi Uppal1, Manoj Kumar Rohit2, Parag Barwad1
1Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Insights
Transcatheter device closure for patent ductus arteriosus (PDA) using only a venous approach is safe and feasible in children, including infants. This method reduces vascular complications compared to the standard arterial and venous approach.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Transcatheter device closure is a recommended, safe procedure for patent ductus arteriosus (PDA) in children.
- The standard femoral arterial and venous access poses risks of vascular complications, particularly in young infants.
- An isolated venous approach has shown non-inferiority to the standard technique in prior studies.
Purpose of the Study:
- To compare the safety and efficacy of an isolated venous approach versus the standard arterial and venous approach for transcatheter PDA device closure in pediatric patients.
- To assess the feasibility of the isolated venous approach in infants weighing less than 6 kg.
Main Methods:
- Prospective observational study comparing two vascular approaches for PDA device closure.
- 135 children were enrolled: 52 in the venous-alone group (Group I) and 83 in the standard group (Group II).
- Comparison of baseline data, procedural outcomes, vascular complications, and radiation dose between groups.
Main Results:
- No significant differences in mean fluoroscopic time or air kerma were observed between the groups.
- Vascular site complications occurred in 7.2% of the standard group (Group II), requiring intervention.
- The venous-alone approach demonstrated a lower incidence of vascular complications.
Conclusions:
- Transcatheter PDA device closure utilizing an isolated venous approach is a feasible and safe alternative in pediatric patients, including young infants.
- This technique effectively mitigates the risk of vascular complications associated with arterial access.
- Careful patient selection is essential for successful implementation of the venous-alone approach.
Background:
Transcatheter device closure is a safe procedure recommended in children with patent ductus arteriosus (PDA). While the standard procedure uses arterial and venous femoral access, it poses risk of vascular complications especially in young infants. Isolated venous approach has been tried in a few studies and was found to be non-inferior to the standard technique. In this prospective observational study, we have compared the two vascular approaches of PDA device closure in pediatric patients and have also studied the feasibility of this approach in young children with weight < 6 kg.
Results:
PDA device occlusion was performed with either one of the approaches-venous alone (group I) or standard approach (group II) in a total of 135 children enrolled prospectively. The baseline data, procedural outcomes, vascular complications, and radiation dose were compared between the two groups. Fifty-two and 83 children were included in group I and group II, respectively. A total of 22 children (16%) (13 in group I; 9 in group II) had weight < 6 kg. In group II, 6 children (7.2%) had vascular site complications treated with heparin infusion with two children requiring thrombolysis. Another child in group II developed intravascular hemolysis following residual shunt, requiring surgical device retrieval and closure. No significant differences were observed in mean fluoroscopic time (p = 0.472) and air kerma between the two groups (p = 0.989).
Conclusion:
Transcatheter PDA device closure without arterial access is a feasible and safe option in children including young infants. This technique avoids the risk of vascular complications although requires careful case selection.
