Percutaneous occlusion of vascular malformations in pediatric and adult patients: 20-year experience of a single center.
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.


CONCLUSIONS
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.
Department of Cardiology, Hospital De Santa Marta, Centro Hospitalar De Lisboa Central, Lisbon, Portugal.
Tiago
T
Pereira-da-Silva
Department of Pediatric Cardiology, Hospital De Santa Marta, Centro Hospitalar De Lisboa Central, Lisbon, Portugal.
José Diogo
JD
Martins
Department of Cardiology, Hospital De Santa Marta, Centro Hospitalar De Lisboa Central, Lisbon, Portugal.
Lídia
L
de Sousa
Department of Cardiology, Hospital De Santa Marta, Centro Hospitalar De Lisboa Central, Lisbon, Portugal.
António
A
Fiarresga
Department of Pediatric Cardiology, Hospital De Santa Marta, Centro Hospitalar De Lisboa Central, Lisbon, Portugal.
Conceição
C
Trigo Pereira
Department of Cardiology, Hospital De Santa Marta, Centro Hospitalar De Lisboa Central, Lisbon, Portugal.
Rui
R
Cruz Ferreira
Department of Pediatric Cardiology, Hospital De Santa Marta, Centro Hospitalar De Lisboa Central, Lisbon, Portugal.
Fátima
F
Ferreira Pinto
D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011174:Portugal; D011474:Prosthesis Design; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D055815:Young Adult
arteriovenous fistula; arteriovenous malformation closure; coil/device/transcatheter embolization; innovation; interventional devices; pediatric intervention