Abstract No. 410: The use of the patent ductus venosus as an access for portal vascular interventions in children

Abstract

The ductus venosus, a fetal communication between the portal and systemic venous circulations, spontaneously closes early in the neonatal period. The persistence of the ductus venosus is rare and can be primary (congenital) or secondary to abnormal portal hemodynamics. Vascular anomalies of the portal vein can be associated with serious clinical presentation and pose technical challenges at interventions. In such patients, the patent ductus venosus provides a safe and valuable alternative access for endovascular treatment. 4 children (age: 2 months 6 years) underwent interventional treatment of vascular anomalies of the portal vein using the patent ductus venosus as a vascular conduit to the portal vein via a transjugular approach. Two patients had arterioportal fistulae; one had a large portosystemic shunt with severe gastrointestinal bleeding and one congenital hemangioma with heart and liver failure. Mesenteric arteriography was initially performed followed by transjugular access of the patent ductus venosus and embolization of the portal anomaly. All the procedures were technically successful using the patent ductus venosus. In patient # 1 with a fistula between the inferior phrenic artery and portal vein, the shunt was embolized with coils. Patient # 2 had a complex arterioportal shunt with a giant portal aneurysm was embolized with an Amplatzer septal occluder and coils. The portosystemic shunt in patient # 3 was closed using an Amplatzer vascular plug. Embolization of the portal feeding tributaries to the liver hemangioma in patient # 4 was done with coils. The procedures were technically successful in the four children without complications. The arterioportal fistula (patient # 1) and the portosystemic shunt (patient # 3) were completely obliterated and clinically successfully. Though technically successful, the response to embolization in patients # 2 and 3 (complex arterioportal fistula and congenital liver hemangioma, respectively) was partial; largely related to other serious comorbidity. Patent ductus venosus provides an invaluable safe access for endovascular portal venous interventions in children.