Transjugular Patent Ductus Arteriosus Occlusion in Seven Dogs Using the Amplatzer Vascular Plug II

Abstract

Although vascular plugs for the closure of patent ductus arteriosus (PDA) have been validated in dogs, studies are lacking on its use as a first-choice device with a transjugular approach. The present case series describes the transvenous right jugular embolization of PDA using an Amplatzer Vascular Plug II in seven dogs of different ages, breeds, and body weights. Complete closure of the PDA was demonstrated in all cases. All dogs showed significant hemodynamic reduction of pulmonary overcirculation and left heart size after the procedure and at following echocardiographic check-ups. Transjugular PDA occlusion using an Amplatzer Vascular Plug II can thus be considered as a safe alternative to the arterial or venous femoral approach using an Amplatzer canine ductal occluder (ACDO), particularly in puppies with small femoral vessels.

Transjugular occlusion of large patent ductus arteriosus with an Amplatzer™ muscular Ventricular Septal Defect occluder in a 3-month-old dog

“…These ACDO, respectively, require a minimal inner diameter of the delivery sheath of 0.073, 0.086, and 0.099 inches, corresponding to 6, 7, or 8 French outer diameter introducers. Therefore, we attempted occlusion using a 16 mm (AVPII as previously described ( Bagardi et al ., 2022 ) with an expected ratio of 1.6 between device diameter and ampulla diameter, somewhat higher than other investigators have recommended (1.2–1.5) ( Belachsen et al ., 2022 ; Hildebrandt et al ., 2022 ). We decided to use a larger up-sized device because of the minimally tapering ductus morphology and the low ratio of the maximal ampulla width to the minimal PDA diameter.…”

“…Anesthesia was induced and maintained as previously described ( Bagardi et al ., 2022 ) and perioperative intravenous amoxicillin (22 mg/kg) was administered. The dog was placed in left lateral recumbency on the fluoroscopy table, the right jugular vein was surgically isolated by a cut-down technique, and an 11 Fr, 10 cm long introducer vascular sheath (Pinnacle Peripheral Introducer Sheath, Terumo Medical Corporation, Somerset, NJ) was inserted into the jugular vein.…”

“…However, the ACDO delivery system size and the need to use this device via a transarterial approach limits its use in very small dogs, especially when presenting with large-sized PDAs ( Singh et al ., 2012 ; Morgan et al ., 2022 ). In addition, the need for femoral artery ligation or a long period of vessel compression can lead to serious local complications ( Bagardi et al , 2022 ). Consequently, investigators have examined Amplatzer™ vascular plugs II (AVPII) (AGA Medical Corporation, Plymouth, MN), or coils for interventional closure of PDA through a transvenous approach, in dogs where routine ACDO closure is not possible ( Blossom et al ., 2010 ; Bagardi et al ., 2022 ; Belachsen et al ., 2022 ; Hildebrandt et al ., 2022 ; Morgan et al ., 2022 ).…”

Percutaneous shunt vessel embolisation with Amplatzer vascular plugs II and IV in the treatment of dogs with splenophrenic shunts: four cases (2019‐2022)

“…Although there are reports of AVP used in cardiovascular veterinary medicine (Bagardi et al . 2022, Belachsen et al . 2022, Hildebrandt et al .…”

“…The multi-layered, double-lobed design of the AVP IV enables rapid embolization, can accommodate tortuous vessels, and is available up to 8 mm (Ramakrishnan 2015). Although there are reports of AVP used in cardiovascular veterinary medicine (Bagardi et al 2022, Belachsen et al 2022, Hildebrandt et al 2022, Ostenkamp et al 2022, there are only two reports of AVP treatment of CPSSs (Weisse et al 2005, Hogan et al 2010. To date, there are no reports of using AVP for splenophrenic shunts.…”