THERAPY AND PREVENTION VASCULAR ANOMALIES Coil embolization of congenital thoracic vascular anomalies in infants and children

When significant thoracic vascular anomalies occur in children, they may present surgical difficulties making operative management undesirable. The recent development of a new, accurate coil-delivery system has enabled us to embolize 17 vessels in five children by passing Gianturco steel coils coated with thrombogenic Dacron strands through No. 5 or 6F end-hole catheters suitable for infants. Coils of 0.038 inch packed diameter were fed through the catheter lumen by a flexible guidewire emerging as 3, 5, or 8 mm diameter loose coils. Fifteen of 17 vessels were successfully occluded. No complications or errors in placement of coils occurred. Four of five children clearly benefitted from the procedure. One died in spite of partial occlusion. Coil embolization can be performed accurately and safely even in small infants with a high rate of successful occlusion and may prove to be a valuable adjunct to operative management. Circulation 70, No. 2, 285-289, 1984. ABNORMAL VASCULAR communications can occur within the chest either as isolated lesions or in association with other congenital anomalies. Their significance is quite varied; however, those that do warrant occlusion can present special surgical difficulties that make operative management undesirable. Previous reports of nonoperative occlusion of thoracic vascular structures in children have described transcatheter embolization with an assortment of thrombogenic debris, including bucrylate adhesive,' detachable silicone balloons,2-5 and steel coils.6 7 In general, the use of these techniques has been restricted to older children and adults. Hazards have included inappropriate embolization5 6 1, Of hardware with occlusions of normal vascular structures, as well as failure to occlude the vascular anomaly.>' In children, successful closure of only 10 thoracic vessels among 14 attempts has been described, with inadvertent embolization of two normal vessels. -6 Thus experience in children with thoracic vascular anomalies is not sufficient to allow assessment of the From the Departments of Pediatric Cardiology and Vascular Radiology, University of Minnesota Hospitals, Minneapolis. Supported by grant HL 28241 from the NIH and by the Dwan Family Fund. Address for correspondence: Bradley P. Fuhrman, M.D., Box 94 Mayo Memorial, University of Minnesota Hospitals, 420 Delaware St. S.E., Minneapolis, MN 55455. Received Feb. 29, 1984; revision accepted April 19, 1984. Dr. Lock is supported by an Established Investigator Award of the American Heart Association. Vol. 70, No. 2, August 1984 risks and benefits of transcatheter embolization, nor does it permit comparison of the various techniques. This report describes the steel coil embolization of 17 thoracic vessels in five children with a new, accurate coil-delivery system and compares results of that procedure with those of previously described techniques.