Gianturco Coils Research Articles

Renal angiomyolipoma: selective arterial embolization--effectiveness and changes in angiomyogenic components in long-term follow-up.

To evaluate the efficacy of selective arterial embolization in symptomatic renal angiomyolipoma (AML) and the change in angiomyogenic components during long-term follow-up after embolization. Fourteen adult patients with symptomatic AMLs underwent 16 selective arterial embolizations. The embolic materials used were absolute alcohol with (n = 5) or without (n = 3) iodized oil, Gianturco coils (n = 4), and polyvinyl alcohol foam powder with gelatin sponge (n = 2). Follow-up ultrasonography and computed tomography (CT) were performed in six and 14 patients, respectively. The effectiveness of selective arterial embolization was evaluated on the basis of the area of the angiomyogenic components in the AML on initial and follow-up images and clinical improvement. All patients showed devascularization of the tumor on the postembolization angiograms. In 13 patients, clinical symptoms disappeared. The follow-up period was 7-72 months (mean, 33 months). One patient underwent nephrectomy at 7 months after embolization because of a large cystic lesion found at 1 month. In long-term CT follow-up (> or =12 months) in 12 patients, nearly all angiomyogenic components disappeared, but fatty components partially shrank with liquefactive necrosis in tumors. Selective arterial embolization is an effective and safe treatment of AML. The angiomyomatous components crucial for the prevention of bleeding were very sensitive to the embolization.

Ay Method Providing Bidirectional Control of Coil Delivery in Occlusions of Patent Ductus Arteriosus With Shallow Ampulla and Pott's Shunts

A novel method using a snare and bioptome to provide bidirectional control of a Gianturco coil for occlusion of a patent ductus arteriosus with a shallow ampulla and Pott's shunts is presented. This method greatly reduces the risk of coil embolization and optimizes coil position in difficult cases.

Long-term Results of Transrenal Ureteral Occlusion with Use of Gianturco Coils and Gelatin Sponge Pledgets

To evaluate transrenal ureteral occlusion with Gianturco coils and gelatin sponge pledgets. The authors reviewed 34 ureteral occlusions in 22 patients during a 4-year period. The indications for this procedure included vesicovaginal fistula in 11 patients and urinary incontinence in three patients. All patients except one had a history of pelvic malignancy and previous radiation therapy. Pre-existing percutaneous nephrostomy tubes were in place in 20 ureters to be embolized. Distal ureteral occlusion was achieved by placement of Gianturco coils alone or in combination with gelatin sponge pledgets. A percutaneous nephrostomy catheter was then placed to provide permanent external diversion. Follow-up ranged from 2 weeks to 29 months (mean, 6.2 months). Occlusion was technically successful in all embolized ureters. All patients experienced prompt resolution of symptoms as indicated by complete or near complete perineal dryness within 72 hours. Complications were limited to coil migration into the renal pelvis in two patients and nephrostomy catheter occlusion requiring replacement in another three patients. Ureteral occlusion with Gianturco coils and gelatin sponge is a safe and reliable method of achieving permanent supravesical urinary diversion in the management of chronic lower urinary tract fistulas.

Transcatheter occlusion of native persistent ductus arteriosus using conventional Gianturco coils

Our short-term results suggests that transcatheter closure of PDA with the Gianturco coil is safe and efficacious. However, caution should be exercised in their use in small children who require multiple coils in view of the potential complication of left pulmonary artery stenosis.

New technique using temporary balloon occlusion for transcatheter closure of patent ductus arteriosus with Gianturco coils.

We describe our early experience with a new technique involving temporary balloon occlusion for transcatheter closure of patent ductus arteriosus (PDA) using single or multiple Gianturco coils. Coil occlusion was attempted in 21 patients of median age 3 (range 1-11) years, and angiographic PDA diameter 3.0 mm +/- 0.87 mm. The inflated balloon of a pulmonary wedge pressure catheter over a transductal wire was used to mechanically hold the first extruded loop of the coil at the pulmonary end of the duct. If a residual shunt persisted after the delivery of the first coil, additional coils were delivered with or without the balloon support. One to nine coils (median 2) of different sizes varying between 3-12 mm diameter and 4-15 cm length were used. Immediate angiographic occlusion rate was 47.6%. However color Doppler (CD) at 24 hours and at 6 weeks revealed complete closure in 66.6% and 80.9%, respectively. Blood transfusion was required in 2 (9.5%) patients. Three out of 56 coils (5.4%) embolized during deployment. The use of balloon occlusion is effective and safe in the treatment of ducti up to 4.7 mm. Residual shunts lend to occlude with time.

Problems encountered during introduction of Gianturco coils for transcatheter occlusion of the patent arterial duct

To define the problems encountered during transcatheter occlusion of the patent arterial duct using Gianturco coils. Between January 1994 and November 1995, 93 patients were admitted in whom it was intended to occlude the patent arterial duct using Gianturco coils. Anterograde transcatheter coil occlusion was performed via the femoral vein in 81 patients. In the remaining 12 the procedure was done via the femoral artery. Coils were implanted successfully in 82/93 (88%) patients. In 11 patients the procedure was a failure. In 19/93 patients (20%), inadvertent embolization of the coil occurred. The coils were retrieved in all except one patient. In 17 of these patients, new coils were then reimplanted successfully. Doppler echocardiography after the procedure showed that in 9/82 (11%) patients the left pulmonary artery Doppler peak velocity exceeded 1.5 m.s-1 (mean 1.2 m.s-1) raising concern about left pulmonary artery branch stenosis. The complete occlusion rate at discharge from hospital was 72/82 (88%). Follow-up ranges from 1 day to 14 months (mean 2/12 months) in the 82 patients in whom successful deployment of coils was possible. In two patients, the arterial duct became occluded at follow-up. One additional patient had complete occlusion after reocclusion using another coil. Thus, after short-term follow-up a total of 75/82 patients (91.4%) have a completely occluded arterial duct after coil implantation. Transcatheter occlusion of the patent arterial duct using Gianturco coils is an effective and safe technique. In the learning curve there is a relatively high rate of inadvertent embolization, but the coils can be retrieved in the vast majority of patients. The complication rate is offset by the high early occlusion rate and the inexpensiveness of the procedure.

Transcatheter closure of large patent ductus arteriosus (> or = 4 mm) with multiple Gianturco coils: immediate and mid-term results.

To assess the immediate and mid-term results of transcatheter closure of patent ductus arteriosus (PDA) > or = 4 mm with multiple Gianturco coils. (Transcatheter closure of large PDAs using the Rashkind occluder or the buttoned device is associated with a 7-38% incidence of residual shunt.) 19 patients (7 male, 12 female) underwent an attempt at anterograde transcatheter closure with multiple Gianturco coils of a large PDA at a median age of 3.8 yr (range 2 weeks-34 yr) and median weight of 14 kg (range 2.3-80 kg). The median PDA diameter at the narrowest segment was 4.3 mm (range 4-7 mm) and the mean (SD) Qp/Qs was 1.9 (0.8). Each patient had left atrial and left ventricular volume overload. A 4F catheter was used to deliver the coils in all patients. There was immediate and complete closure in 16/18; one patient had residual shunt that was closed at a second procedure and the other had spontaneous disappearance of the residual shunt at the six week visit. A short ductus (angiographic type B) in one patient could not be closed. The median number of coils placed at the first attempt to close the ductus was 4 (range 2-6 coils) and the median fluoroscopy time was 40 minutes (range 13-152 minutes). Mild left pulmonary artery stenosis occurred in the two smallest patients. Coil migration to the lung occurred in 3 patients with retrieval of coils in two patients. All procedures but one were done on an outpatient basis. At a median follow up of 1.6 yr (range 2 weeks-2.2 yr) all patients had complete closure with no new complications. Anterograde transcatheter closure with multiple Gianturco coils is an effective treatment for most patients with large PDA of diameters up to 7 mm. This technique can be performed in small infants on an outpatient basis without the need for general endotracheal anaesthesia.

Transcatheter closure of the patient ductus arteriosus in adults using the Gianturco coil.

Although results of surgical ligation of the patent ductus arteriosus (PDA) in the pediatric age group are excellent, surgical management of the adult with a PDA may be more problematic. The PDA that presents in adulthood may be calcified and friable, rendering simple ligation via a thoracotomy difficult, inadequate, and hazardous. Patch closure of the ductus arteriosus from either the aortic or pulmonary artery orifice using cardiopulmonary bypass or transient aortic cross-clamping is necessary but increases surgical risk. Furthermore, older patients with diseases unrelated to their PDA and patients with Down's syndrome may have higher risks with intubation, general anesthesia, and surgery. Early results of percutaneous transcatheter occlusion of the PDA with Gianturco coils performed under sedation and local anesthesia are promising. Six adults with mean age of 39.1 years (range 23.1-62.0 years) were found to have an isolated PDA with mean minimum diameter of 2.7 mm (range 1.0-5.0 mm) at cardiac catheterization. All underwent percutaneous transcatheter occlusion of the PDA using Gianturco coils. Coil implantation was successful in all patients. There were no complications and all were discharged home within 24 hours. Complete ductal occlusion was seen immediately in 4 of 6 patients (67%) while 2 of 6 (33%) had small residual leaks. However, complete occlusion was achieved in all patients by 6 months following the procedure. Transcatheter occlusion of the PDA using coils is safe and efficacious in adults.

Transcatheter closure with single or multiple Gianturco coils of patent ductus arteriosus in infants weighing ≤8 kg: Retrograde versus antegrade approach

Experience with transcatheter closure (TCC) of patent ductus arteriosus (PDA) in small infants is limited. Our goals were to evaluate the immediate and short-term results of TCC of PDA in small infants (≤8 kg) as attempted with single or multiple Gianturco coils and to compare results for PDA ≤2.5 mm versus PDA >2.5 mm. Twenty-four infants underwent an attempt at TCC of PDA at a median age of 0.7 years (range 2 weeks to 1.5 years) and median weight of 6.5 kg (range 2.3 to 8 kg). Coils were placed by the transvenous route in 14 patients and by the transarterial route in 10 patients. The median PDA diameter was 2.7 mm (range 0.4 to 5.2 mm). Ten patients had PDA diameters <2.5 mm and all had complete closure, 9 with a single coil and 1 with two coils. Fourteen patients had PDA diameters ≥2.5 mm; closure was complete in 10 patients, 9 of whom required multiple coils. There was a trend toward improved results with multiple coils delivered transvenously. There was immediate complete closure of the PDA with a diameter as large as 5.2 mm that persisted at a median follow-up period of 1.2 year. Closure was unsuccessful in 4 patients, each of whom required multiple coils. The median fluoroscopy time was 19 minutes. Complications included transient loss of femoral pulse in 2 infants, mild left pulmonary artery obstruction in 2, and nonretrievable coil migration to the right lung in one. We conclude that TCC is effective therapy for small infants with a PDA of diameter ≤5.2 mm by the single- or multiple-coil technique on an outpatient basis and that TCC can be performed in neonates as small as 2.3 kg.

Coil occlusion of congenital vascular malformation and surgical shunts

This article reviews the applications (excluding patent ductus arteriosus) of Gianturco coils in pediatric cardiovascular disease. The most common application is closure of aortopulmonary collaterals. Multiple additional applications have been developed. Coil technology and delivery technique are also reviewed.

Repositionable Vascular Occluder: Experimental Comparison with Standard Gianturco Coils

To evaluate the efficacy and recanalization rates of a newly designed vascular occlusion device. The self-expanding vascular occluder was braided from fine nitinol wires and filled with polyester fibers. The device was delivered through a 6-F polyethylene introducing sheath with use of a delivery cable with a microscrew adaptor. Comparison was made between one occlusion plug and two Gianturco coils placed in the corresponding contralateral arterial segment in nine dogs and six pigs. The mean diameter of the targeted vessels was 4.8 mm +/- 0.8. Two animals were killed immediately after occlusion, and the remaining 13 animals underwent follow-up angiography at 1 week and/or 1 month, after which the animals were killed and the vessels were explanted for gross and histopathologic examination. Significantly shorter time-to-occlusion was achieved with the nitinol plug compared with two Gianturco coils (1.73 minutes +/- 1.28 vs 5.73 minutes +/- 6.18; P = .021). The recanalization rate at 1 month was also significantly lower (36.4% vs 81.8%, P = .027). The occlusion time was strongly dependent on the target artery diameter with Gianturco coils (R = .79, P = .0007), and not with the nitinol plug. The nitinol vascular occluder appears highly effective and reliable, with one plug resulting in significantly faster and longer lasting occlusions compared with two Gianturco coils. The new device can be repositioned prior to release, therefore allowing optimal positioning.

Closure of residual leak after umbrella occlusion of the patent arterial duct, using Gianturco coils

Residual leak after transcatheter occlusion of the patent arterial duct (PDA) using the Rashkind double umbrella technique is a well documented problem. At our institution, there is a 15% incidence of persistent residual leak after 12 months. Since September 1994, 15 patients have undergone successful occlusion of the residual leak using single or multiple Gianturco coils. The median age of the patients was 48 months (range: 12–354 months). The median fluoroscopy time was 11 min (range: 4–14). There were no complications and no embolization of the coils. Eleven patients had total occlusion demonstrated on angiography 5–10 min after coil occlusion. A further three patients were demonstrated on colour Doppler echocardiography to have no residual leak before discharge the same day — despite a small leak on angiography. Only one of 15 patients had a small residual leak at the time of hospital discharge and this was finally occluded 1 year later with another coil. Coil occlusion of a residual leak on the umbrella device is effective and a safe and reliable procedure which appears to be an improvement on using a second umbrella device.

Closure of residual leak after umbrella occlusion of the patent arterial duct, using Gianturco coils.

Residual leak after transcatheter occlusion of the patent arterial duct (PDA) using the Rashkind double umbrella technique is a well documented problem. At our institution, there is a 15% incidence of persistent residual leak after 12 months. Since September 1994, 15 patients have undergone successful occlusion of the residual leak using single or multiple Gianturco coils. The median age of the patients was 48 months (range: 12-354 months). The median fluoroscopy time was 11 min (range: 4-14). There were no complications and no embolization of the coils. Eleven patients had total occlusion demonstrated on angiography 5-10 min after coil occlusion. A further three patients were demonstrated on colour Doppler echocardiography to have no residual leak before discharge the same day-despite a small leak on angiography. Only one of 15 patients had a small residual leak at the time of hospital discharge and this was finally occluded 1 year later with another coil. Coil occlusion of a residual leak on the umbrella device is effective and a safe and reliable procedure which appears to be an improvement on using a second umbrella device.

Transcatheter occlusion of the arterial duct with Cook detachable coils: early experience.

To assess the effectiveness of modified, controlled release Gianturco coils for transcatheter occlusion of the arterial duct. Prospective study, approved by local medical ethics committee. Tertiary paediatric cardiac centre. 43 patients with left to right shunting through the arterial duct, two of whom had a residual leak after surgical ligation and three had residual shunting after previous Rashkind umbrella implantation. Transcatheter delivery of one or more coils to the arterial duct. Complete occlusion of the arterial duct, based on intention to treat and judged by Doppler echocardiography. Absence of flow disturbance in the branch pulmonary arteries and the descending aorta following the procedure. Assessment of cost of the disposable items used. At a median follow up period of three months complete duct occlusion was achieved in 37 (86%) of the 43 patients. No flow disturbance in the branch pulmonary arteries or the descending aorta was detected in any patient. The median cost of disposable items used during the procedure was 342 pounds. The Cook detachable coil is an effective and financially attractive alternative to the Rashkind umbrella for closure of the arterial duct.

Unraveling of a Gianturco coil during reocclusion of a patent ductus arteriosus

Unraveling of a Gianturco coil during reocclusion of a patent ductus arteriosus

Interventional cardiac catheterization therapy for combined coarctation of the aorta and patent ductus arteriosus: Successful outcome in two infants

We report two infants each with coarctation of the aorta and small patent ductus arteriosus who had balloon angioplasty therapy for aortic obstruction at 3-6 months of age followed by anterograde placement of a single Gianturco coil to close the ductus at a separate catheterization. One infant developed recoarctation that resolved with repeat angioplasty prior to closure of the ductus. Follow-up evaluations have demonstrated a trivial aortic gradient, no aortic aneurysm, and no residual shunt.

Interventional cardiac catheterization therapy for combined coarctation of the aorta and patent ductus arteriosus: Successful outcome in two infants

We report two infants each with coarctation of the aorta and small patent ductus arteriosus who had balloon angioplasty therapy for aortic obstruction at 3–6 months of age followed by anterograde placement of a single Gianturco coil to close the ductus at a separate catheterization. One infant developed recoarctation that resolved with repeat angioplasty prior to closure of the ductus. Follow-up evaluations have demonstrated a trivial aortic gradient, no aortic aneurysm, and no residual shunt. © 1996 Wiley-Liss, Inc.

Transcatheter closure of the patent ductus arteriosus: Comparison between the Rashkind occluder device and the anterograde Gianturco coils technique

Thirty-five patients (mean age 43.7 months, mean weight 13 kg) underwent anterograde patent ductus arteriosus (PDA) occlusion with Gianturco coils (coil group). These patients were compared with 35 age- and weight-matched patients who underwent closure of their PDA with the Rashkind umbrella device (device group). The mean PDA diameter at its narrowest point was 2.8 mm in the coil group and 2.7 mm in the device group. There was immediate closure angiographically in 20 (57%) of 35 in the coil group compared with 9 (26%) of 35 for the device group. Color flow mapping before discharge revealed complete closure in 30 (86%) of 35 in the coil group compared with 18 (51%) of 35 in the device group (chi square = 9.5455, p < 0.005). Mean fluoroscopy time was 18.5 minutes (median 13.5 minutes) and 14.7 minutes (median 13 minutes) for the coil and device, respectively. Four coils and one device embolized down the pulmonary artery; all were successfully retrieved in the catheterization lab. Coil closure of the small to moderate PDA is safe and effective. It is more effective in achieving immediate closure than the Rashkind device. More clinical trials with the coil technique are warranted to establish the long-term results of this technique.

Additional aortopulmonary collaterals in patients referred for coil occlusion of a patent ductus arteriosus

Coexisting aortopulmonary collaterals in patients diagnosed with a patent ductus arteriosus (PDA) are rare findings. Percutaneous transcatheter closure of PDA and requisite aortography offer an unique opportunity to identify and treat these systemic arterial anomalies, which would be missed by echocardiographic evaluation alone. The significance of these collaterals is unclear, but it may contribute to left heart dilation from additional left to right shunting in patients with an otherwise isolated small PDA. Of 18 patients undergoing transcatheter occlusion of a PDA with Gianturco coils, 2 were found to an additional significant aortopulmonary collaterals, which were also occluded. © 1996 Wiley-Liss, Inc.

Long-term survival after embolization of potentially lethal bleeding malignant pelvic tumours.

Transcatheter embolization was performed in 45 patients suffering from potentially lethal bleeding originating from malignant tumours in the pelvic region. In 21 cases, the basic disease was rectosigmoidal and in 20, gynaecological in origin. Uncommon bleeding sites were embolized in four other cases. The median survival time (Kaplan-Meier) was 6 months. Most patients died from tumour cachexia. In 10 cases (22%), recurrent bleeding occurred, in three of these with lethal consequences. Successful reembolization was performed on seven patients. The different embolization materials used showed a minor impact on the therapeutic result. Embolization therapy proved to be an effective measure in potentially lethal malignant pelvic bleeding. Gianturco, Anderson and Wallace (GAW) coils should be given preference where there is urgency, as they are accurate, easily and quickly insertable, and cause few complications.