Use of simultaneous fluoroscopic and echocardiographic guidance during transarterial coil placement for embolization of patent ductus arteriosus in dogs

Viktor Szatmári Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 8, 3584 CM, Utrecht, The Netherlands.

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Arnold A. Stokhof Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 8, 3584 CM, Utrecht, The Netherlands.

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Abstract

Objective—To evaluate the use of simultaneous fluoroscopic and transthoracic echocardiographic guidance during transarterial coil placement for embolization of patent ductus arteriosus (PDA) in dogs.

Design—Descriptive report.

Animals—3 dogs with PDA.

Procedure—Each dog was anesthetized, and a femoral artery was exposed for vascular access. By use of an introducer, a catheter was placed in the thoracic portion of the descending aorta with fluoroscopic guidance, and subsequently, a bolus of iodinated radiographic contrast material was injected to outline the ductus. Under fluoroscopic guidance, 1 coil was positioned in the ductus, but not released. Transthoracic echocardiography was used to ensure that 1 loop of the coil was located in the pulmonary artery. When > 1 loop or no loops were detected in the pulmonary artery, the coil was retrieved and repositioned; when 1 loop of the coil was detected in the pulmonary artery, the coil was detached. After catheter removal, the femoral artery was ligated and the wound was closed.

Results—In all 3 dogs, successful embolization of the PDA was achieved. Echocardiography prevented unintentional pulmonary artery embolization in 1 dog and suboptimal coil placement in the other 2 dogs.

Conclusions and Clinical Relevance—In addition to fluoroscopic control, transthoracic echocardiography appears to aid the appropriate positioning of a transarterial coil for treatment of PDA in dogs. Although transesophageal echocardiography would likely provide better images of the ductus, transthoracic echocardiography is a much cheaper, less specialized, and more widely available alternative.

Abstract

Objective—To evaluate the use of simultaneous fluoroscopic and transthoracic echocardiographic guidance during transarterial coil placement for embolization of patent ductus arteriosus (PDA) in dogs.

Design—Descriptive report.

Animals—3 dogs with PDA.

Procedure—Each dog was anesthetized, and a femoral artery was exposed for vascular access. By use of an introducer, a catheter was placed in the thoracic portion of the descending aorta with fluoroscopic guidance, and subsequently, a bolus of iodinated radiographic contrast material was injected to outline the ductus. Under fluoroscopic guidance, 1 coil was positioned in the ductus, but not released. Transthoracic echocardiography was used to ensure that 1 loop of the coil was located in the pulmonary artery. When > 1 loop or no loops were detected in the pulmonary artery, the coil was retrieved and repositioned; when 1 loop of the coil was detected in the pulmonary artery, the coil was detached. After catheter removal, the femoral artery was ligated and the wound was closed.

Results—In all 3 dogs, successful embolization of the PDA was achieved. Echocardiography prevented unintentional pulmonary artery embolization in 1 dog and suboptimal coil placement in the other 2 dogs.

Conclusions and Clinical Relevance—In addition to fluoroscopic control, transthoracic echocardiography appears to aid the appropriate positioning of a transarterial coil for treatment of PDA in dogs. Although transesophageal echocardiography would likely provide better images of the ductus, transthoracic echocardiography is a much cheaper, less specialized, and more widely available alternative.

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