2.3. Transcatheter Plug Closure

DSA was performed using the transfemoral route using angiographic contrast injected at a dose of 1 ml/kilogram per second from a 5F angiographic catheter (Starway, China). Thoracic aortography was then performed to achieve an approximate view of aberrant BAs or collateral arteries. In addition, selective angiograms identified the anomalous arteries that were characterized by dilation and tortuosity, which clearly paralleled the bronchi and the bleeding sites of target vessels. The vascular plug (Starway Cardi-O-Fix Plug Occluder, Beijing, China) was used in each patient (size of the plug selected was in accord with the diameter of targeted vessels) using a transition system comprising 4F/5F catheters, of which an actual picture was displayed in Figure 1. This procedure was conducted by a professional group that was comprised of two to three cardiologists who had command of the procedure from over 10-year experience, a radiographic professor, and members of the Catheterization Center at CHCMU. Commonly, the plug device was placed on the sites closing to the origin of targeted vessels, and its diameter was 2-4 mm larger than the narrowest one located at the target vessels for loading. In situations where patients had more than one visible abnormal BA with different origins and diameters, we occluded the artery burdening main blood perfusion of vascular lesions. Finally, an instant postocclusion angiograph displayed the volume of residual shunts that was used to evaluate the possibility of postoperative pulmonary hemorrhage.

An actual picture of plug device (Starway, Cardi-O-Fix Plug Occluder).