Coil embolization of congenital thoracic vascular anomalies in infants and children.

Abstract

When significant thoracic vascular anomalies occur in children, they may present surgical difficulties making operative management undesirable. The recent development of a new, accurate coil-delivery system has enabled us to embolize 17 vessels in five children by passing Gianturco steel coils coated with thrombogenic Dacron strands through No. 5 risks and benefits of transcatheter embolization, nor does it permit comparison of the various techniques. This report describes the steel coil embolization of 17 thoracic vessels in five children with a new, accurate coil-delivery system and compares results of that procedure with those of previously described techniques. MethodsFive infants and children were shown at cardiac catheterization to have congenital thoracic vascular anomalies. Findings were reviewed in a combined cardiovascular surgery, vascular radiology, pediatric cardiology conference, and transcatheter embolization was recommended. Patients were recatheterized. Arterial or venous access was gained with a No. 5 or 6F endhole catheter, and embolization was accomplished with Gianturco steel coils, uniformly coated with thrombogenic Dacron strands (figure 1). As previously described,9 coils of 0.038 inch packed diameter were straightened over a thin wire and fed through the catheter lumen by a flexible guidewire, emerging in the abnormal vessel as a loose coil of 3, 5, or 8 mm diameter. Extremely flexible guidewires were used to avoid displacement of the catheter tip during the procedure. After placement of coils, occlusion occurred by thrombosis, generally within 10 min. If complete occlusion was not angiographically apparent 5 or 10 min after initial placement, smaller coils were lodged in the remaining vessel lumen to further obstruct the vessel. The first coil was chosen so that extruded diameter exceeded the angiographically estimated vessel lumen by about 50%.

Percutaneous transcatheter occlusion of coronary artery fistulas using detachable balloons

“…Since then a variety of thrombogenic materials have been developed for transcatheter embolization procedures. Some of these devices, including wire coils [7,13,21,23] [4,20], and dysrhythmias [17]) some method of occluding these malformations is generally advocated. Spontaneous closure of congenital coronary fistulas has been reported but remains a rare event [9, ll, 16].…”

Biodegradation of tungsten embolisation coils used in children

“…In the first transcatheter coil embolisation, Fuhrman et al [7] used Gianturco steel coils with Dacron strands. Gianturco steel coils, usually delivered through a 6-F catheter, were also used in the largest study on aorto-pulmonary collateral vessels reporting on the embolisation of 77 vessels in 54 children [8].…”

Closure of a coronary cameral fistula following endomyocardial biopsies in a cardiac transplant patient with a detachable balloon

“…Such a fistula might lead to right ventricular overload, predispose to endocarditis or cause myocardial ischaemia by the coronary steal phenomenon [16,17]. As transcatheter embolisation has been shown to be a safe and effective approach for the closure of coronary artery fistulae, this method was chosen for closing the coronary-camera1 fistula in this patient [8,9,18]. However, because of the large diameter and enormous flow through this fistula, two coils were dragged down the fistula.…”

“…2b). At first we choose a braided 50 mm long coil, with a coiled diameter of 5 mm, which was advanced through the delivery catheter by flushing the catheter and pushing the coil out of the catheter into the distal part of the fistula by a coil pusher as described earlier [8,9]. After freeing, the coil curved by the inbuilt memory into a trefoil leaf appearance.…”