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使用Amplatzer血管封堵器II对16只犬的动脉导管未闭进行经静脉栓塞:改良技术及并发症描述

Transvenous embolization of patent ductus arteriosus in 16 dogs using the Amplatzer Vascular Plug II device: description of a modified technique and complications.

作者信息

Dubès Antoine, Thambo Jean-Benoît, Loyer Virginie, Menaut Pierre

机构信息

AniCura Aquivet Veterinary Hospital, Mérignac, France.

Medical and Surgical Cardiology Unit of the Fœtus, Child and Adult, Cardiology Hospital "Haut Lévêque", Pessac, France.

出版信息

J Vet Med Sci. 2024 Oct 1;86(10):1089-1095. doi: 10.1292/jvms.23-0445. Epub 2024 Sep 2.

Abstract

Patent ductus arteriosus (PDA) is a deadly congenital disease in dogs if left untreated. Occlusion of the defect is the treatment of choice and can be achieved by surgical ligation or interventional closure. In this retrospective study of 16 dogs, an alternative to the classically used canine device which is placed by an arterial route is described. The Amplatzer Vascular Plug II (AVPII) can be deployed by a transvenous approach, using a modified and simplified technique using a single catheter to perform angiography and device delivery. This allows the percutaneous treatment of smaller dogs <3 kg and the concomitant treatment of pulmonic stenosis if present. Successful and complete closure was achieved in all dogs with a mean device/ampulla diameter ratio of 1.28 and a mean device/ostium ratio of 3.6. Embolization into the pulmonary artery was observed in one dog where the device/ampulla diameter ratio was <1.1 and device/ostium ratio was <2.1. In conclusion, our study confirms that PDA transvenous closure using the AVPII appears to be a viable alternative to transarterial closure, allowing the treatment of smaller dogs and a fully percutaneous approach. Care should be taken in patients with very large ducti where undersizing might result in device embolization.

摘要

动脉导管未闭(PDA)在犬类中若不治疗是一种致命的先天性疾病。封堵缺损是首选治疗方法,可通过手术结扎或介入封堵来实现。在这项对16只犬的回顾性研究中,描述了一种替代经典使用的经动脉途径放置的犬用装置的方法。Amplatzer血管封堵器II(AVPII)可通过经静脉途径部署,使用一种改良和简化的技术,用一根导管进行血管造影和装置输送。这使得体重小于3千克的小型犬能够接受经皮治疗,并且如果存在肺动脉狭窄也可同时进行治疗。所有犬均成功实现完全封堵,装置/壶腹直径平均比值为1.28,装置/开口比值为3.6。在一只装置/壶腹直径比值<1.1且装置/开口比值<2.1的犬中观察到了肺动脉栓塞。总之,我们的研究证实,使用AVPII经静脉封堵PDA似乎是经动脉封堵的一种可行替代方法,允许治疗小型犬并采用完全经皮途径。对于导管非常粗大的患者应谨慎操作,因为尺寸过小可能导致装置栓塞。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/748a/11442394/b95339decf31/jvms-86-1089-g001.jpg

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