Experiência clínica com a utilização de plugs vasculares Amplatzer®

Abstract

Clinical Experience with Amplatzer ® Vascular Plugs Background: The Amplatzer ® vascular plugs I and II (AVPs I and II) are low profile self-expandable devices made of nitinol, designed for vascular occlusions. We report our experience with these devices in two tertiary referral hospitals. Method: Retrospective study of patients undergoing vascular occlusion procedures with AVPs since 2005. The devices were 30%-50% larger than the target vessel, deployed under general anesthesia via femoral and internal jugular vein or femoral and brachial artery, and delivered through guiding catheters or 5 F to 8 F long sheaths. Results: Fourteen patients (50% male) at a median age of 5 years (11 months to 70 years) and a median weight of 15 kg (8 kg to 67 kg) were identified. Seventeen AVPs were used: 2 AVPs II and 15 AVPs I, with a diameter ranging from 4 mm to 16 mm. In 3 patients with more than one vessel to occlude, 2 AVPs were implanted in each vessel. In 3 patients with coronary fistula total occlusion of the vessels occurred after 24 hours. In 2 patients with modified Blalock-Taussig shunts, there was total occlusion of the anastomosis, with the use of additional coils in one. In 3 patients with venovenous fistulas after Glenn or Fontan operations, there was complete occlusion of the vessels and improved saturation, with the use of additional coils in one. Another patient with venovenous fistula had mild residual shunt in the lab and total occlusion observed at echocardiographic monitoring within 24 hours. Two patients with multiple pulmonary arteriovenous malformations underwent closure using the AVP, other Amplatzer devices and Gianturco's coils, with minimal residual shunts in all cases. In 2 patients with systemic-pulmonary collaterals in the postoperative period of pulmonary atresia and VSD repair, there was complete occlusion with the aid of additional coils, one immediately after the procedure and the other within 24 hours. In one patient with scimitar syndrome the systemic collateral vessel was totally occluded. There was no embolization or death. Conclusion: The AVPs were appro-RESUMO

Embolizaço percutânea de fístulas arteriovenosas pulmonares em paciente com telangiectasia hemorrágica hereditária

“…For this reason, it was chosen to use the Amplatzer TM Vascular plug with larger dimensions than that of adductor vessels, preventing the risk of embolization. These were important for the posterior positioning of multiple coils due to the persistent flow through the fistula, after five days of follow-up, a technique succesfully used by Pereira et al 8 The concomitant presence of patent foramen ovale increased the chance of paradoxical thromboembolism, and, therefore, it was occluded with a 25-mm Cardia prosthesis, guided by transesophageal echocardiography. Although the patent foramen ovale was small, had a short tunnel, and did not present interatrial septal aneurysm, the decision to occlude it was based on the presence of right-to-left shunt through the interatrial septum in a patient with multiple previous episodes of cerebrovascular accident.…”

Oclusão percutânea de defeitos cardíacos congênitos e estruturais com amplatzer duct occluder II TM

“…No paciente portador de fístula arteriovenosa pulmonar com vaso nutridor proveniente da artéria pulmonar direita (Figura 6), a prótese foi avançada por via femoral dentro de um sistema TorqVue LP TM 5 F passado coaxialmente por dentro de uma bainha longa 7 F posicionada na artéria pulmonar direita, de acordo com técnicas semelhantes já descritas. 25,26 Tal artifício foi empregado para se obter maior estabilidade dos sistemas de entrega no local desejado durante o implante, além de possibilitar injeções de contraste pelo braço lateral da bainha longa 7 F para averiguação do posicionamento correto da prótese. A comunicação interatrial tipo ostium secundum de 11 mm foi ocluída posteriormente com a técnica habitual, empregando-se dispositivo Amplatzer Septal Occluder TM (ASO) de 14 mm.…”

Utilização de plugs vasculares Amplatzer® para oclusão de estruturas vasculares anormais

“…Nesta edição da Revista Brasileira de Cardiologia Invasiva, Pereira et al 4 relatam sua interessante e extensa experiência clínica inicial com o implante percutâneo de plugs vasculares Amplatzer ® versões I e II (AGA Medical, Golden Valley, Estados Unidos) para a oclusão de diferentes estruturas vasculares anormais.…”

“…Na maioria das séries são reportados casos isolados, com raras exceções. [5][6][7] Levando-se em conta essa realidade, a experiência publicada por Pereira et al 4 contribui de maneira significativa para demonstrar a eficácia clínica do fechamento desses tipos de defeito com plugs vasculares.…”