Clinical applications of vascular plug to occlude shunts or collaterals

Clinical applications of vascular plug to occlude shunts or collaterals

Clinical applications of vascular plug to occlude shunts or collaterals

(구연):
Release Date : 2013. 10. 19(토)
Gi Young Jang, Kee Soo Ha, Chang Sung Son, Joo Won Lee
Department of Pediatrics, Korea University Hospital
장기영, 하기수, 손창성, 이주원
고려대학교 의과대학 소아과학교실

Abstract

Purpose : Vascular Plug is an established embolic device that can be an alternative to coils or detachable balloons to embolize medium to large vessels with high flow. We report early and intermediate-term results after closure of various kinds of shunts or collateral vessels using the Amplatzer vascular plug (AVP). Methods : Between Aug. 2010 and Jan. 2013, 7 patients (4 males, 3 females) were subjected to attempted percutaneous closures of various kinds of shunts or collaterals vessel using the AVP. Follow-up evaluations were conducted using an echocardiogram at 1 day and 1, 3 months after the performance of the transcatheter closure. Results : Median age of patients at catheterization was 6 years (range 1.4 to 33 years), median weight was 15 kg (range 8 to 65 kg). There were 2 patients with Blalock-Taussig (B-T) shunt, 3 patients with Patent ductus arteriosus ( PDA), 1 patient with collateral vessel (MAPCA), and 1 patient with fistula between left superior caval vein and left pulmonary artery. AVP-I was used in 3-patients (2 patients with B-T shunt, 1 patient with with fistula between left superior caval vein and left pulmonary artery), AVP-II was used in 3-patients (2 patients with PDA, 1 patient with MAPCA), AVP-IV was used in 1-patient with PDA. It’s not easy to occlude B-T shunt using the AVP because of the tight curve formed by the innominater artery and B-T shunt. So, we use the catheter-snare technique and retrograde approach method to occlude B-T shunt. 2 patients with PDA had a long-narrowed ampulla, so, it’s not possible to use Amplatazer duct occluder, Nit-Occlud, or detachable coils. To close long-narrowed PDA, AVP-II was used. Complete occlusion was noted after transcatheter closure in 100% of patients at 24 hours. Recanalization was not detected in all patients at 1 year follow-up. Any complications were not detected during or after catheterization. Conclusions : Transcatheter closure of various kinds of shunts or collateral vessel using the AVP is safe and effective therapy. And to get a good outcome, it’s important to understand about anatomy, hemodynamics, and lesion entities of target vessels, and proper selection of device type among the AVP family series is also important.

Keywords: Vascular Plug, Shunt, Collaterals