Percutaneous occlusion of vascular malformations in pediatric and adult patients: 20‐Year Experience of a Single Center

Abstract

Objective: A case series on different vascular malformations (VM) treated with percutaneous occlusion in children and adults is presented. Background: Percutaneous occlusion is usually the preferred treatment method for VM. Previous series have mostly focused on single types of devices and/or VM. Methods: Retrospective analysis of all patients who underwent percutaneous occlusion of VM in a single center, from 1995 to 2014, excluding patent ductus arteriosus. Clinical and angiographic data, procedural details, implanted devices, and complications were assessed. Procedural success was defined as effective device deployment with none or minimal residual flow. Predictors of procedural failure and complications were determined by multivariate analysis. Results: A total of 123 VM were intervened in 47 patients with median age of 12 years (25 days-76 years). The VM included 55 pulmonary arteriovenous fistulae, 39 aortopulmonary collaterals, 10 systemic venovenous collaterals, 8 peripheral arteriovenous fistulae, 5 Blalock-Taussig shunts, 4 coronary fistulae, and 2 Fontan fenestrations. The 143 devices used included 80 vascular plugs, 38 coils, 22 duct occluders, and 3 foramen ovale or atrial septal defect occluders. Median vessel size was 4.5 (2.0-16.0) mm and device/vessel size ratio was 1.4 (1.1-2.0). Successful occlusion was achieved in 118 (95.9%) VM, including three reinterventions. Four (3.3%) clinically relevant complications occurred, without permanent sequelae. Lower body weight was independently associated with procedural failure and complications. Conclusion: To our knowledge, this is the largest series on different VM occluded percutaneously in children and adults, excluding patent ductus arteriosus. Percutaneous occlusion was effective and safe, using different devices. V C 2015 Wiley Periodicals, Inc.

Long Term Consequences of the Fontan Procedure and How to Manage Them

“…to recur after coiling or device closure [89]. Closure of venovenous collaterals in some series has been found to be associated with a higher overall mortality rate [90].…”

Covidien micro vascular plug in congenital heart diseases and vascular anomalies: A new kid on the block for premature babies and older patients

“…Transcatheter therapies for congenital heart diseases (CHD) and vascular anomalies such as patent ductus arteriosus, aortopulmonary collaterals, congenital, and acquired veno‐venous collaterals have been widely and successfully applied as first‐line management strategy . Multiples devices including nitinol based, self‐expanding occluders devices (Amplatzer vascular plug, Amplatzer duct occluders from St Jude, Lifetech, or more recently Occlutech), or coils are currently used . While device closure of these anomalies in the current area is deemed low risk, premature and low birth weight babies continue to pose challenges .…”