Surgical interventions for patent ductus arteriosus (PDA) in dogs typically yield favourable outcomes when performed by skilled surgeons. Mortality rates for experienced surgeons, having conducted over 100 procedures, range from 0% to 2%, indicating a high success rate. However, despite the overall effectiveness of the procedure, potential complications must be considered (Orton & Monnet, 2017).
One of the most severe complications associated with PDA ligation is haemorrhage, occurring in approximately 6.25% of cases. Haemorrhage typically arises during dissection around the medial aspect of the PDA near the right pulmonary arterial junction, especially when surgeons attempt to visualize the tips of the right-angle forceps. While small ruptures may respond to digital tamponade, further dissection can exacerbate the situation, potentially leading to increased mortality rates, which can range from 42% to 100%. Additionally, postoperative deaths have been reported due to the rupture of an aortic aneurysm, highlighting the critical nature of surgical procedures involving the PDA.
Numerous studies have investigated risk factors associated with both short- and long-term complications following surgical ligation of a PDA. For instance, a study conducted in 1976 by Eyster et al. reviewed 100 cases of PDA and found an 8% mortality rate among surgically managed dogs. Factors such as the absence of electrocardiographic (ECG) evidence of atrial fibrillation, no clinical signs of congestive heart failure (CHF), age younger than two years, and weight less than 23 kg were associated with better survival outcomes. Conversely, dogs presenting with ECG documentation of atrial fibrillation and mitral regurgitation had a higher mortality rate within the first-month post-surgery. Another extensive review involving 201 dogs undergoing surgical ligation of a PDA found no correlation between long-term patient survival and age, body weight, level of surgical training, or surgical technique. However, intraoperative complications, such as haemorrhage from the PDA, negatively affected long-term survival.
In a more recent study conducted in 2005, factors such as age, weight, lethargy, pre-operative treatment with angiotensin-converting enzyme inhibitors, and right atrial dilation on radiography were found to be negatively associated with survival. Despite these risk factors, most dogs undergoing PDA ligation surgery survived beyond one year postoperatively, with a survival rate of 92% and 87% surviving up to 2 years.
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and do the same for this This procedure has a limitation based on the size of the patient. Animals need to weigh at least 2.5 kg because of the device sizes currently available. Also, using the canine ductal occluder to close the duct is not recommended for dogs with a type III ductal shape (Orton & Monnet, 2017).
Primary procedure-related complications with PDA occlusion using ACDO include device infection, device dislocation, and femoral artery rupture (Stauthammer, 2015). Device infection is considered severe because it is rarely successfully treated with antibiotics and may lead to septic embolism (Fine & Tobias, 2007). Maintaining aseptic conditions in a hygienic environment can help prevent infection. Patients should undergo optimal screening for infections through blood tests and urine cultures before the procedure. Perioperative antibiotics, although controversial, may be administered for 1-2 weeks following the procedure (Stauthammer, 2015). Elective surgeries or dental treatments are not recommended within the first three months postoperatively. After this period, the device is covered with vascular endothelium and is no longer in contact with potential bacteria. Device dislocation is exceptionally rare and appears well-tolerated by the patient if the device embolizes the pulmonary vasculature (Gordon et al., 2010; Nguyenba & Tobias, 2008). The embolized device does not seem to hinder lung function. If necessary, the device can be removed. Femoral artery rupture is mainly risky in small patients (Stauthammer, 2015).
ACDO is a non-invasive method with a low complication rate (3-7%) and high ease of use Nguyenba & Tobias, 2007). Several small studies have demonstrated promising results with a total mortality of 0% and a success rate of 94-100% Leakage from the ductus after ACDO placement is observed in <6% of cases, and device dislocation in 3% (Stauthammer, 2015).
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