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Published on: July 21, 2013
Single catheter approach for occlusion of a patent arterial duct with a Rashkind double umbrella
S E Abrams1, K P Walsh, E A McDonald
1Heart Clinic, Royal Liverpool Children's Hospital, Alder Hey, Liverpool.
Insights
Using a single venous catheter and angiogram for patent arterial duct closure with the Rashkind double umbrella significantly reduces procedure time, radiation exposure, and costs compared to using both venous and arterial catheters.
Area of Science:
- Cardiovascular Interventions
- Pediatric Cardiology
Background:
- Patent arterial duct (PAD) closure is a common pediatric cardiac procedure.
- Traditional methods involve venous and arterial catheters and multiple angiograms, increasing procedure complexity and risks.
Purpose of the Study:
- To evaluate the benefits of a simplified technique for PAD closure using the Rashkind double umbrella.
- This technique utilizes a single venous catheter and a single angiogram.
Main Methods:
- Retrospective review of 103 consecutive patient cases undergoing PAD closure.
- Comparison between the traditional venous and arterial method (54 implantations) and the simplified venous-only method (50 implantations).
Main Results:
- The venous-only method significantly reduced median procedure times (70 vs. 90 minutes), angiogram numbers (1 vs. 4), and angiographic dye volume (2 vs. 7 ml/kg).
- No significant difference in fluoroscopy time was observed between the two methods.
Conclusions:
- A simplified technique using a single venous catheter and angiogram for PAD closure with the Rashkind double umbrella offers considerable improvements.
- Benefits include reduced radiation exposure, lower risk to arteries, shorter procedures, and decreased equipment costs without compromising outcomes.
Objectives:
To determine the benefits of using a single venous catheter and a single angiogram during catheter occlusion of a patient arterial duct with the Rashkind double umbrella compared with those of venous and arterial catheters and multiple angiograms.
Design:
Retrospective review of case notes.
Patients:
103 consecutive patients. The long sheath could not be advanced adequately in two patients. 101 patients had 104 implantations. Median (range) age was 35 (7-549) months and median (range) weight 13 (7-62) kg. Fifty four implantations were performed using the venous and arterial method and 50 using the venous only method.
Results:
Median procedure times (70 v 90 min), number of angiograms (one v four), and angiographic dye volume used (2 v 7 ml/kg) were significantly reduced using the venous only method compared with those of the venous and arterial method. There was no significant difference in fluoroscopy time (venous only 9 v venous and arterial 10 min).
Conclusions:
Considerable improvements can be made in the technique of catheter closure of patent arterial ducts using the Rashkind double umbrella without compromising outcome using venous cannulation alone and a single angiogram, rather than venous and arterial cannulation and multiple angiograms. reduced risk to arteries from cannulation, The benefits are reduced radiation exposure, reduced risk to arteries from cannulation, shorter procedures, and lower equipment costs.
