Low profile vascular plug for transarterial occlusion of patent ductus arteriosus in small dogs

Abstract

Background Minimally invasive transcatheter occlusion using Amplatz canine duct occluder (ACDO) is the treatment of choice for dogs with left‐to‐right shunting patent ductus arteriosus (PDA). However, in small dogs the femoral artery diameter is often too small to accommodate the guiding catheter required for ACDO deployment. Objective Describe the effectiveness of transarterial implantation of Amplatzer Vascular Plug 4 (AVP‐4), the only self‐expandable nitinol mesh occlusion device which can be implanted through a 4 French diagnostic catheter, in small dogs with left‐to‐right shunting PDA. Animals Seven client‐owned dogs. Methods Descriptive case series. Dogs with hemodynamically relevant left‐to‐right shunting PDA and a femoral artery diameter less than 2.0 mm measured preoperatively with ultrasonography were prospectively enrolled. Results Angiography after releasing the device showed complete immediate PDA closure in 5 dogs, where the manufacturers' recommendation were strictly followed (30%‐50% device oversizing of the ductal ampulla's diameter). Trivial residual flow on angiography in the 6th dog, whose device was slightly undersized, had resolved on echocardiography within 2 hours after placement. Marked device undersizing in the 7th dog resulted in severe residual shunting, which necessitated the addition of a coil. In this dog, the AVP‐4 embolized into the pulmonary artery within 2 weeks after placement. Conclusions and Clinical Importance Transarterial implantation of AVP‐4 is a safe, effective and technically easy procedure for PDA occlusion in small dogs and offers a valuable alternative to coil implantation. Accurate PDA measurement and device sizing is essential to prevent residual shunting, inadvertent device embolization, and protrusion of the device into the aorta.

Closure of patent ductus arteriosus with a vascular plug in a German Shepherd dog

“…This patient exhibited a similar shape and was diagnosed with type II A PDA. Type II A PDAs typically respond well to transcatheter occlusion using ACDO or vascular plug; thus, the patient underwent the procedure (Nguyenba and Tobias, 2007;Hulsman et al, 2021).…”

Transvenous embolization of moderate to large patent ductus arteriosus in dogs using the Amplatzer vascular plug II

“… 35 Currently, transarterial PDA embolization using AVP‐IV has been described in 2 case series of small dogs with a very small femoral arteries. 36 , 37 Because of the shape of the AVP‐IV with 2 symmetrical lobes, it would be possible to use it via a transvenous route.…”

“… 2 , 6 , 31 Postoperative device embolization is described rarely in dogs after PDA occlusion using Gianturco coils 6 , 16 , 42 as well as with ACDO 2 in the first 24 hours after intervention. Delayed embolization in the following days to weeks is described rarely in case reports in dogs with ACDO, 43 AVP‐II, 44 and AVP‐IV 36 and often associated with severe cardiorespiratory compromise. 43 , 44 …”

Key considerations in the approach to congenital heart disease in dogs and cats

“…Treatment options for PDA continue to expand to include low profile devices for the smallest patients, novel approaches and techniques for closing unique ductal morphologies (Hulsman et al . 2020, Patata et al . 2020, Kharbush & Trafny 2021).…”