Transvenous embolization of moderate to large patent ductus arteriosus in dogs using the Amplatzer vascular plug II

Two- and three-dimensional transesophageal echocardiographic assessment and successful occlusion of a window-like patent ductus arteriosus in two dogs

A 16-month-old Labrador-poodle cross (case 1) and a 3-month-old German shorthaired pointer (case 2) were referred for patent ductus arteriosus (PDA) occlusion. Two-dimensional transthoracic and two- and three-dimensional transesophageal echocardiography revealed a window-like PDA characterized by a wide and short ductus. Due to the atypical PDA morphology with no ampulla in case 1, ductal occlusion was attempted with non-canine-specific Amplatzer occluder devices. However, these were too small and failed to remain stable. Amplatz Canine Duct Occluder (ACDO) devices were used with success in both cases. Due to the defects' morphology, the proximal ACDO disc protruded into the aorta but there were no signs of obstruction to aortic blood flow 16 months (case 1) and 1 month (case 2) post-occlusion. We describe two cases of a window-like type PDA that were successfully occluded with an ACDO.

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

OBJECTIVES

To describe the treatment of four dogs with splenophrenic shunts using percutaneous shunting vessel embolisation with Amplatzer vascular plugs II and IV and provide information on their clinical outcomes.

MATERIALS AND METHODS

Dogs with splenophrenic shunts treated at a veterinary hospital from January 2019 to December 2022 were identified through a medical record search.

RESULTS

Six dogs with splenophrenic shunts were identified. Two dogs were excluded because they were treated with laparoscopic surgery. Four underwent percutaneous shunting vessel embolization with Amplatzer vascular plugs and were included in the case series. A sheath was placed in the left external jugular vein and a balloon catheter was advanced to the shunting vessel under fluoroscopy. Portal vein pressure was confirmed to be within an acceptable range during temporary balloon occlusion. Based on preoperative CT angiography and intraoperative contrast examination, Amplatzer vascular plugs II were selected for two dogs and IV were selected for two dogs. Under fluoroscopy, the plug was deployed into the shunting vessel, and angiography confirmed occlusion. In all cases, the increase in portal pressure after temporary occlusion was within the acceptable range, and complete occlusion of blood flow was possible with a single plug. There were no major procedure-related complications. No dogs developed post-ligation seizures or signs of portal hypertension. In addition, improvements in ammonia values were observed in all cases.

CLINICAL SIGNIFICANCE

Percutaneous splenophrenic shunt embolisation using Amplatzer vascular plugs II and IV is technically feasible in dogs, and assessed by intra-procedure angiography, a single plug completely obstructed blood flow in all dogs. Based on the literature search, this is the first report describing Amplatzer vascular plugs for the treatment of splenophrenic shunts.

Transjugular occlusion of large patent ductus arteriosus with an Amplatzer™ muscular ventricular septal defect occluder in a 3-month-old dog

Background

Cardiologists close most patent ductus arteriosus (PDA) defects in dogs using the Amplatz® canine duct occluder via a transarterial approach. However, this approach can be problematic in small dogs due to the small femoral artery diameter. In such cases, cardiologists have opted to use coils or vascular plugs deployed from a transvenous approach. However, in small dogs with large PDA, the risk of device protrusion into the pulmonary artery, incomplete closure, or device embolization, often leads to surgical PDA closure via thoracotomy.

Case Description

The present report describes a 3-month-old male 6 kg Border collie with a large, PDA which was successfully occluded using the Amplatzer™ muscular ventricular septal defect (mVSD) device from a transvenous approach after closure attempts with an Amplatzer™ vascular plug II failed.

Conclusion

This is the first case report in veterinary medicine of PDA closure with an Amplatzer™ mVSD occluder device. This approach, described in PDA closure in people, could be considered in minimally invasive PDA closure in small dogs with challenging anatomy.

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

Simple Summary

This study outlines the authors’ experience using the Amplatzer Vascular Plug II device for occlusion of patent ductus arteriosus (PDA) in dogs through a right transjugular approach, never before described in veterinary medicine for this purpose. The obtained results demonstrate that the use of the Amplatzer Vascular Plug II via a transvenous right jugular approach is a feasible and effective method, even in small-sized patients. The authors’ experience is that the transvenous approach is a safe and effective method for PDA occlusion in dogs. Furthermore, the right jugular approach provides easier and faster vascular access than the femoral one. The authors affirm that this approach, together with the properties of the Amplatzer Vascular Plug II and its wide size selection, potentially provide a novel method that can complement the current available methods for transcatheter PDA occlusion.

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.