Percutaneous thrombin injection in an infant to treat hepatic artery pseudoaneurysm after failed embolization

Area of Science:

• Pediatric Interventional Radiology
• Vascular Surgery
• Pediatric Gastroenterology

Background:

• Hepatic artery pseudoaneurysms (HAPs) in children, often resulting from liver trauma, typically require surgical or endovascular intervention.
• Percutaneous thrombin injection (PTI) is an established treatment for HAPs in adults, but its use in infants is not well-documented.
• High-grade liver lacerations pose significant challenges for managing associated vascular injuries in pediatric patients.

Observation:

• This report details the successful application of PTI in an 11-month-old infant with a grade IV liver laceration.
• The patient presented with a pseudoaneurysm of a left hepatic arterial branch.
• Previous superselective transcatheter arterial embolization had failed to achieve thrombosis.

Findings:

• Percutaneous thrombin injection was performed by pediatric radiologists skilled in ultrasound-guided techniques.
• The procedure successfully achieved thrombosis of the hepatic artery pseudoaneurysm in the infant.
• This represents the first reported use of PTI in an infant for this indication.

Implications:

• PTI is a safe and effective minimally invasive treatment option for hepatic artery pseudoaneurysms in infants, even after other interventions fail.
• This technique expands the interventional radiology armamentarium for managing complex pediatric liver trauma.
• Further studies are warranted to establish standardized protocols and long-term outcomes for PTI in neonates and infants.