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  • Title: Low profile vascular plug for transarterial occlusion of patent ductus arteriosus in small dogs.
    Author: Hulsman AH, Breur JMPJ, Szatmári V.
    Journal: J Vet Intern Med; 2021 Jan; 35(1):98-106. PubMed ID: 33242371.
    Abstract:
    BACKGROUND: Minimally invasive transcatheter occlusion using Amplatz canine duct occluder (ACDO) is the treatment of choice for dogs with left-to-right shunting patent ductus arteriosus (PDA). However, in small dogs the femoral artery diameter is often too small to accommodate the guiding catheter required for ACDO deployment. OBJECTIVE: Describe the effectiveness of transarterial implantation of Amplatzer Vascular Plug 4 (AVP-4), the only self-expandable nitinol mesh occlusion device which can be implanted through a 4 French diagnostic catheter, in small dogs with left-to-right shunting PDA. ANIMALS: Seven client-owned dogs. METHODS: Descriptive case series. Dogs with hemodynamically relevant left-to-right shunting PDA and a femoral artery diameter less than 2.0 mm measured preoperatively with ultrasonography were prospectively enrolled. RESULTS: Angiography after releasing the device showed complete immediate PDA closure in 5 dogs, where the manufacturers' recommendation were strictly followed (30%-50% device oversizing of the ductal ampulla's diameter). Trivial residual flow on angiography in the 6th dog, whose device was slightly undersized, had resolved on echocardiography within 2 hours after placement. Marked device undersizing in the 7th dog resulted in severe residual shunting, which necessitated the addition of a coil. In this dog, the AVP-4 embolized into the pulmonary artery within 2 weeks after placement. CONCLUSIONS AND CLINICAL IMPORTANCE: Transarterial implantation of AVP-4 is a safe, effective and technically easy procedure for PDA occlusion in small dogs and offers a valuable alternative to coil implantation. Accurate PDA measurement and device sizing is essential to prevent residual shunting, inadvertent device embolization, and protrusion of the device into the aorta.
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