ABSTRACT
Introduction Gianturco coils were originally developed for the closure of undesirable vessels in the late 1970s.1 They have been used successfully in a variety of situations by interventional radiologists and later by pediatric cardiologists.2,3 Initial reports of the use of Gianturco coils for the patent ductus arteriosus (PDA) were published in the early 1990s.4 Coil occlusion is now almost universally established as a simple, safe, and effective technique for occlusion of the small PDA, which measures less than 2 or 3 mm in diameter at its narrowest point (which is usually at the site of insertion of the duct into the pulmonary artery).5,6
Coil occlusion of larger ducts is technically more challenging because of a greater tendency for coil embolization.7 Various technical modifications have been suggested to reduce the risk of embolization of these coils. They include the use of detachable coils,8 deployment of thicker (0.052 inch) coils,9 simultaneous deployment of two or more coils,10 snare-assisted delivery,11 and bioptomeassisted delivery.12-14 Occlusive devices such as the Amplatzer Duct Occluder (ADO) overcome many limitations of the coils for closure of large PDAs and allow for better control and safety. Most institutions now prefer occlusive devices for PDAs that are > 3 mm.15,16 These devices are, however, considerably more expensive than coils and in many developing countries device closure costs substantially more than surgical closure. The bioptome-assisted coil occlusion technique has emerged as a less expensive alternative to the ADO.13,14 With careful attention to case selection and technique it is possible to coil occlude the majority of ducts. Furthermore, in specific instances, such as in selected small infants, coil occlusion may have an advantage over the ADO. This chapter will describe case selection strategies and the coil occlusion techniques in detail for small as well as large ducts.
