The efficacy and safety of the Amplatzer ductal occluder in young children and infants

2005 ◽  
Vol 15 (3) ◽  
pp. 279-285 ◽  
Author(s):  
Jameel Al-Ata ◽  
Amin M. Arfi ◽  
Arif Hussain ◽  
Amjad A. Kouatli ◽  
M. Omar Jalal
Keyword(s):  
Young Children ◽  
Pulmonary Arteries ◽  
Major Complication ◽  
High Rate ◽  
Excessive Bleeding ◽  
Descending Aorta ◽  
Complete Occlusion ◽  
Transcatheter Occlusion ◽  
Occluder Device ◽  
Aortic Obstruction

Background: We have used the Amplatzer ductal occluder for transcatheter closure of large persistently patent arterial ducts, and used our experience to assess the safety and efficacy of the device in young children and infants. Methods and patients: We used the Amplatzer ductal occluder prospectively in 43 patients with large patent arterial ducts, reviewing our experience to identify any problems or complications. Results: The procedure proved successful in 42 of the patients. We achieved complete occlusion of the duct in 33 (78.5 per cent) of the patients on the day of insertion. In 6 additional patients, complete occlusion occurred 1 week to 6 months after the procedure. Trivial leaks persisted in 2 patients, while one had a significant residual leak. Problems were encountered in 7 patients. The procedure failed in one, a device was wasted in 2, pulled through in 3, while we experienced kinking of the long Mullins sheath, being unable to retrieve the device, in one patient. Minor complications occurred in 6 patients, finding flow at a peak velocity of 2.2 metres per second in the descending aorta in 2 patients, and at 2.5 metres per second in 2 further patients, and flow at 2.5 metres per second in the pulmonary arteries of two patients. One patient experienced a major complication due to excessive bleeding. Out of the 14 patients suffering adverse events, 13 weighed less than 10 kilograms. This rate of problems and complication in these patients weighing less than 10 kilograms was significantly higher than in the patients weighing more than 10 kilograms. Conclusion: Transcatheter occlusion of moderate to large patent arterial ducts with the Amplatzer ductal occluder device is safe and effective, with a high rate of complete occlusion. Problems and minor complications may be encountered in children weighing less than 10 kilograms. If the device is to be deployed completely in the ductal ampulla, and to avoid descending aortic obstruction, the size of the retention flanges of the occluder should not exceed the largest diameter of the patent arterial duct.

Transvenous Treatment of Carotid Cavernous and Dural Arteriovenous Fistulae: Results for 31 Patients and Review of the Literature

Neurosurgery ◽  
2003 ◽  
Vol 53 (4) ◽  
pp. 836-857 ◽  
Author(s):  
Joachim Klisch ◽  
Hans Juergen Huppertz ◽  
Uwe Spetzger ◽  
Andreas Hetzel ◽  
Wolfgang Seeger ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Symptoms ◽  
Sigmoid Sinus ◽  
High Rate ◽  
Technical Success ◽  
Arteriovenous Fistulae ◽  
Time Resolved ◽  
Complete Occlusion ◽  
Technical Success Rate ◽  
Age Range

Abstract OBJECTIVE To evaluate findings for patients with carotid cavernous fistulae or dural arteriovenous fistulae (AVFs) who underwent transvenous embolization via different transvenous approaches. METHODS Retrospective analysis of data for 31 patients (age range, 17–81 yr; mean age, 59.3 yr) with carotid cavernous fistulae (n = 6) or dural AVFs (cavernous sinus [CS], n = 11; transverse/sigmoid sinus, n = 14) was performed. The AVFs were treated with coils via different transvenous approaches, in 56 procedures. Doppler ultrasonography and time-resolved, two-dimensional, magnetic resonance projection angiography were performed to confirm the treatment. The mean clinical follow-up period was 32.5 months. RESULTS A total of 34 transvenous procedures were performed for 17 AVFs of the CS. Eleven patients with AVFs of the CS (63%) were cured with respect to clinical symptoms, and six patients experienced improvement (37%). The approach via the internal jugular vein and inferior petrosal sinus (n = 15) was possible in 60% of cases, with complete occlusion of the fistula in 78% of cases. With the approach via the facial vein (n = 8), there was a 50% success rate. The superior ophthalmic vein approach (n = 5) was associated with a high rate of technical success (100%), with a rate of complete fistula occlusion of 80%. We encountered complications, with transient morbidity, in four cases (23.5%). For 14 dural AVFs of the transverse/sigmoid sinus, 22 transvenous procedures were performed; 12 patients were cured (85.7%) and 2 experienced improvement (14.3%). The technical success rate was 86%, with complete occlusion in 42% of cases. Minor complications occurred in six cases (42.9%) but did not lead to permanent morbidity. CONCLUSION Transvenous treatment of CS and transverse/sigmoid sinus AVFs can be effective if all transvenous approaches, including combined surgical/endovascular approaches, are considered.

Mechanisms of Respiratory Inhibition Produced by Sudden Aortic Obstruction

1958 ◽  
Vol 194 (1) ◽  
pp. 155-159 ◽  
Author(s):  
Thomas M. Gilfoil ◽  
Robert T. Schopp ◽  
Gail R. Norris ◽  
W. B. Youmans
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Morphine Sulfate ◽  
Respiratory Center ◽  
Neural Pathways ◽  
Descending Aorta ◽  
Respiratory Inhibition ◽  
Before And After ◽  
Thoracic Part ◽  
Aortic Obstruction

External constriction of the descending aorta elicits immediate inhibition of breathing in dogs under Pentothal-chloralose anesthesia both before and after sino-aortic denervation. Impulses initiated by traction of a ligature on the aorta are conducted into the thoracic part of the cord. There is no indication that this mechanism is activated in experiments involving internal occlusion in the innervated animals. Internal occlusion of the descending aorta elicits inhibition of breathing in dogs under morphine sulfate-chloralose anesthesia having all neural pathways intact. The inhibition is related in large part to reflexes from the sino-aortic zones. In the majority of dogs studied the delayed inhibition of breathing following internal occlusion of the descending aorta was greatly reduced but usually not entirely eliminated by sino-aortic denervation. Therefore, some other respiration-inhibiting mechanism is involved. That the respiratory center may be relatively insensitive to changes in blood flow under the conditions of these experiments is indicated by the fact that in individual cases sudden severe changes in blood pressure in sino-aortic denervated animals were not accompanied by changes in respiration.

Transcatheter occlusion of moderate to large patent arterial ducts, having a diameter above 2.5 mm, with the Amplatzer Duct Occluder. Comparisons with the Rashkind, buttoned devices, and coils in 116 consecutive patients

2003 ◽  
Vol 13 (5) ◽  
pp. 413-419 ◽  
Author(s):  
François Godart ◽  
Christian Rey ◽  
Patrick Devos ◽  
Georges-Marie Brevière ◽  
Charles Francart
Keyword(s):  
Safe Procedure ◽  
Amplatzer Duct Occluder ◽  
Tertiary Referral Centre ◽  
Minimum Diameter ◽  
Complete Occlusion ◽  
Transcatheter Occlusion ◽  
Intention To Treat ◽  
Amplatzer Device ◽  
Detachable Coils

Aim: To report results of transcatheter occlusion of moderate to large patent arterial ducts, having a minimum diameter above 2.5 mm, with the Amplatzer duct occluder, and to compare these with results achieved using Rashkind or Sideris devices and Cook detachable coils. Design and setting: Retrospective study conducted on intention-to-treat data from a tertiary referral centre. Patients: Since 1989, 116 consecutive patients, 77 females and 39 males, underwent percutaneous closure with several devices. We used the Rashkind double umbrella in 23 patients, the Sideris buttoned device in 39 patients, coils in 17 patients, and the Amplatzer duct occluder in 37 patients. The median age of the patients was 37 months, and the median weight 13 kg. The mean minimum diameter of the duct was 3.8 ± 1.22 mm, with a median of 3.5 mm, and range from 2.5 to 10 mm. Results: Implantation succeeded in all but 9 of the children (92%). The time of fluoroscopy was shorter, and full occlusion was better as judged on angiography, in patients closed using the Amplatzer device, despite closure of larger ducts, than in patients closed using other devices (p < 0.0001, p = 0.0003, and p = 0.0015 for the Rashkind, Sideris, and coils, respectively). Complications included embolisation in 2 patients, and haemolysis in 3 patients. In 12 patients, a second device was inserted because of residual shunting noted during follow-up. Complete occlusion was achieved earlier after implantation (p = 0.0002), and the rate of complete occlusion was better in patients receiving an Amplatzer device (97%, p = 0.024) than in patients undergoing closure with other devices. Conclusion: Transcatheter closure of moderate to large patent arterial ducts using the Amplatzer duct occluder is an effective and safe procedure, providing better results than those achieved using other occluders.

A Comparative Study of Mechanical Properties of Fresh and Elastic-Network Only Proximal Artery Tissues

2007 ◽  
Author(s):  
Philip Kao ◽  
H. Jerry Qi ◽  
Steve Lammers ◽  
Robin Shandas
Keyword(s):  
Mechanical Properties ◽  
Least Squares Method ◽  
Pulmonary Arteries ◽  
Quantitative Comparison ◽  
Uniaxial Deformation ◽  
Elastic Network ◽  
Descending Aorta ◽  
Material Parameters ◽  
Hyperelastic Model ◽  
Left And Right

The contribution of the elastic network to the mechanical behavior of arterial tissues is not well quantified. This paper focuses on the quantification of the behavior of fresh and elastic-network-only (digested) calf arterial tissues in uniaxial deformation using the anisotropic hyperelastic model proposed by Bischoff et al. ([1]). This model characterizes an orthotropic, hyperelastic response, which is well-suited for the modeling of arterial tissues ([2],[3]). For this paper, we attempt to match the material constants associated with the Bischoff-Arruda anisotropic hyperelastic model to our experimental data from arterial tissues including the ascending aortic arch, descending aorta, main, left, and right pulmonary arteries, using a least-squares method. The material parameters obtained from the data fit provide a quantitative comparison of mechanical properties of fresh artery tissues and elastin networks.

P3721Clinical and echocardiographic outcomes after treatment of patent foramen ovale with two transcatheter occlusion devices: mononcenter observational study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Almalla ◽  
J Schroeder ◽  
E Altiok ◽  
M N Alashkar ◽  
A Kirschfink ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Patent Foramen Ovale ◽  
Percutaneous Treatment ◽  
Foramen Ovale ◽  
Transcatheter Occlusion ◽  
Occlusion Device ◽  
Contrast Enhanced ◽  
Occluder Device ◽  
Ischemic Attack

Abstract Background Percutaneous closure of patent foramen ovale (PFO) after cryptogenic stroke (CS) is strongly recommended in the current guidelines. Most available evidence has been obtained from randomized studies in which Amplatzer PFO occluder device or Groe occluder device were implanted. Several occluder devices are used off-label for percutaneous treatment of PFO. Rate of recurrent CS and rate of residual shunting after percutaneously occlusion of PFO varies between different occlusion devices. To date, there are no randomized clinical studies that compare the effectivity and safety of several devices in patients with CS. Aim The aim of this study was to compare rate of residual shunting and recurrent CS after percutaneus treatment of PFO with the most common used PFO occluder devises. Methods This was a retrospective, non-randomized, monocenter study. Between 2008 and 2014, all patients with CS or transient ischemic attack (TIA) treated with transcatheter occlusion of PFO with Amplatzer PFO occlusion device or Occlutech occlusion device were included. Patients were followed up at 1 and 6 months with contrast-enhanced transesophageal echocardiography (TEE), and at 3 months with contrast-enhanced transthoracic echocardiography. Primary endpoint was residual shunting at 6 months. Secondary endpoint was recurrent CS or TIA at 6 months after the procedure. Results 220 consecutive patients (57±12 year, 131 men) were treated with Amplanz PFO occlusion device (140 patients) or Occlutech PFO occlusion device (80 patients) after CS or TIA. Procedural success was 100% in both groups. Residual shunting was observed directly after the procedure in 26 patients in the Amplatzer group and 22 patients in the Occlutech group (19% and 27%, respectively; p=0.003), at 1 months follow (15% and 25%, respectively; p=0.064) and at 6 months (9% and 16%, respectively; p=0.024). There was no significant difference between both groups according recurrent CS (0.7% and 0%, respectively; p=0.449). At 6 months follow up atrial fibrillation was detected in 2 patients from Amplatzer group and 5 patients from Occlutech group (1.4% and 6.0%, respectively; p=0.050). Death, aortic erosion and pericardial effusion was not observed in both groups. Clinical and echocardiographic outcome Variable Amplatzer occluder device (N=140) Occlutech occluder device (N=80) p-value Clinical outcome at 6 months follow up   Death, n (%) 0 (0%) 0 (0%) 1.000   Stroke, n (%) 1 (1%) 0 (0%) 0.449   Transient ischemic attack, n (%) 0 (0%) 0 (0%) 1.000   Atrial fibrillation, n (%) 2 (1.4%) 5 (6%) 0.050   Aortic erosion, n (%) 0 (0%) 0 (0%) 1.000   Pericardial effusion, n (%) 0 (0%) 0 (0%) 1.000 Echocardiographic Outcome at 6 months follow up   Residual shunting after Implantation directly, n (%) 26 (19%) 22 (27%) 0.003   Residual shunting at one month, n (%) 21 (15%) 20 (25%) 0.064   Residual shunting at 6 months, n (%) 13 (9%) 16 (20%) 0.024 Conclusion Percutaneous treatment of PFO after CS or TIA with Amplatzer PFO occluder device was associated with lower rate of residual shunting and lower rate of atrial fibrillation at 6 months follow up, whereas rate of recurrent CS and TIA was comparable between both groups.

scholarly journals Pipeline embolization device for recurrence of previously treated aneurysms

2017 ◽  
Vol 42 (6) ◽  
pp. E8 ◽  
Author(s):  
David Dornbos ◽  
Constantine L. Karras ◽  
Nicole Wenger ◽  
Blake Priddy ◽  
Patrick Youssef ◽  
...  
Keyword(s):  
Flow Diversion ◽  
High Rate ◽  
Endovascular Coiling ◽  
Vessel Occlusion ◽  
Pipeline Embolization Device ◽  
Complete Occlusion ◽  
Microsurgical Clipping ◽  
Previously Treated ◽  
Angiographic Evidence

OBJECTIVEThe utilization of the Pipeline embolization device (PED) has increased significantly since its inception and original approval for use in large, broad-necked aneurysms of the internal carotid artery. While microsurgical clipping and advances in endovascular techniques have improved overall efficacy in achieving complete occlusion, recurrences still occur, and the best modality for retreatment remains controversial. Despite its efficacy in this setting, the role of PED utilization in the setting of recurrent aneurysms has not yet been well defined. This study was designed to assess the safety and efficacy of PED in the recurrence of previously treated aneurysms.METHODSThe authors reviewed a total of 13 cases in which patients underwent secondary placement of a PED for aneurysm recurrence following prior treatment with another modality. The PEDs were used to treat aneurysm recurrence or residual following endovascular coiling in 7 cases, flow diversion in 2, and microsurgical clipping in 4. The mean time between initial treatment and retreatment with a PED was 28.1 months, 12 months, and 88.7 months, respectively. Clinical outcomes, including complications and modified Rankin Scale (mRS) scores, and angiographic evidence of complete occlusion were tabulated for each treatment group.RESULTSAll PEDs were successfully placed without periprocedural complications. The rate of complete occlusion was 80% at 6 months after PED placement and 100% at 12 months in these patients who underwent PED placement following failed endovascular coiling; there were no adverse clinical sequelae at a mean follow-up of 26.1 months. In the 2 cases in which PEDs were placed for treatment of residual aneurysms following prior flow diversion, 1 patient demonstrated asymptomatic vessel occlusion at 6 months, and the other exhibited complete aneurysm occlusion at 12 months. In patients with aneurysm recurrence following prior microsurgical clipping, the rate of complete occlusion was 100% at 6 and 12 months, with no adverse sequelae noted at a mean clinical follow-up of 27.7 months.CONCLUSIONSThe treatment of recurrent aneurysms with the PED following previous endovascular coiling, flow diversion, or microsurgical clipping is associated with a high rate of complete occlusion and minimal morbidity.

Left aortic arch with right descending aorta and severe coarctation: an unusual “vascular clamp” with airway compression

2018 ◽  
Vol 28 (8) ◽  
pp. 1056-1058
Author(s):  
Ronak Sheth ◽  
Roy Varghese ◽  
Kothandam Sivakumar
Keyword(s):  
Aortic Arch ◽  
Clinical Presentation ◽  
Main Bronchus ◽  
Left Main Bronchus ◽  
Left Main ◽  
Descending Aorta ◽  
Airway Compression ◽  
Rare Congenital Anomaly ◽  
Aortic Obstruction ◽  
Right Descending Aorta

AbstractLeft aortic arch with right descending aorta is a rare congenital anomaly. We describe the clinical presentation of this unusual anomaly associated with cardiorespiratory compromise from severe aortic obstruction and left main bronchus compression. The anatomical peculiarities, embryological basis, and surgical solutions are presented.

scholarly journals An Autopsy Case of Misdiagnosed Wernicke’s Syndrome after Intragastric Balloon Therapy

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Paola Vellante ◽  
Aldo Carnevale ◽  
Cristian D’Ovidio
Keyword(s):  
Bariatric Surgery ◽  
Lower Limb ◽  
Intragastric Balloon ◽  
Major Complication ◽  
Bed Rest ◽  
High Rate ◽  
Self Healing ◽  
Autopsy Case ◽  
Weight Loss Interventions ◽  
Reversible Condition

Intragastric balloon (IGB) therapy is a widely used technique to counter obesity, and it is known to be safe and effective. Although there can be a high rate of side effects following IGB therapy, most are self-healing and they are mainly accommodative in nature. Few cases of Wernicke’s syndrome under IGB therapy have been described in the literature, and to the best of our knowledge, none have been fatal. We present here a case of a 51-year-old woman who underwent IGB therapy over 8 months. Late diagnosed Wernicke’s syndrome that first appeared as lower limb neuropathy progressively immobilized the patient, until she required bed rest. Finally, a major complication of pneumonia caused her death. Wernicke’s syndrome has been mainly related to bariatric surgery techniques, but it must also be linked to IGB therapy (and also to other restrictive weight-loss interventions). As the use of IGB therapy spreads, the literature must alert physicians to this complication. Wernicke’s syndrome is a severe but reversible condition when diagnosed and treated early.

scholarly journals The Patent Ductus Arteriosus in Adults with Special Focus on Role of CT

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2394
Author(s):  
Soo Jeong Lee ◽  
Seung Min Yoo ◽  
Min Ji Son ◽  
Charles S. White
Keyword(s):  
Patent Ductus Arteriosus ◽  
Imaging Modality ◽  
Ductus Arteriosus ◽  
High Rate ◽  
Special Focus ◽  
Clinical Perspective ◽  
Occluder Device ◽  
Missed Diagnosis ◽  
Patent Ductus

The primary imaging modality for the diagnosis of patent ductus arteriosus (PDA) is echocardiography. However, CT may be the technique on which an incidental PDA is first recognized because of the increasing number of chest CT scans performed for a variety of causes. Identification of PDA on CT may lead to earlier closure using a PDA occluder device. Immediate identification of incidental PDA is important, but a high rate of missed diagnosis of PDA has been reported due to its small size and anatomic location. In addition, echocardiography may overlook the presence of even a large PDA due to decrease in the amount of shunting through the PDA caused by high pulmonary artery pressures. This review provides the basic CT anatomy and clinical perspective of PDA, and discusses the role of CT in the evaluation of PDA as well as methods to avoid overlooking a small PDA on CT.

Some simple geometric and mechanical characteristics of mammalian blood vessels

1960 ◽  
Vol 199 (6) ◽  
pp. 1150-1152 ◽  
Author(s):  
Robert L. Evans ◽  
John W. Pelley ◽  
Lowell Quenemoen
Keyword(s):  
Cross Sections ◽  
Mechanical Characteristics ◽  
Pulmonary Arteries ◽  
Descending Aorta ◽  
Individual Variations ◽  
Mammalian Blood ◽  
Moduli Of Elasticity ◽  
Iliac Bifurcation ◽  
Made In

Cross sections, relative thicknesses, longitudinal and circumferential distensibilities and propagation velocities of main arteries of dogs, cats and rabbits were measured in vivo and shortly after excision. A few measurements of main veins and pulmonary arteries were also made in the dog and indicated that the three types of vessels have comparable moduli of elasticity in distention. With a few exceptions, the main arterial cross sections are commensurate with the corresponding flows (as shown by Levy and Blalock's measurements, for example) and have marked tapers in only a few regions (which include the proximal descending aorta, the celiac axis and the iliac bifurcation). Comparable measurements were obtained in vivo and soon after excision, and both showed wide individual variations among the genetically mongrel population.

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