For surgical ligation the chest needs to be opened. The duct will then be identified and closed from the outside using a ligature.
An incision is made in the groin area to identify the femoral artery which is supplying the hind leg with blood. The artery is then punctured and catheters are inserted. The catheters are then advanced towards the heart and the ACDO device is positioned in the PDA vessel following a contrast study which allow to visualise and measure the duct. Following successful closure of the PDA, the femoral artery usually needs to get ligated before closing the skin wound.
The femoral vein is punctured percuntaneously. Catheters are then advanced towards the heart and towards the PDA vessel. Similar to the transarterial closure, a contrast study is needed before the device can be positioned to close the PDA. Following successful closure, patients only get a pressure bandage for 8-12h to avoid bleeding and bruising and most patients will be discharged the following day.