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Interventional embolization of congenital intrahepatic shunts in children
1Cathererization Laboratory, Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China.
Insights
Transcatheter embolization is a viable treatment for congenital intrahepatic shunts in children, offering an alternative to surgery. While effective for many, complex cases may necessitate liver transplantation.
Area of Science:
- Pediatric Interventional Radiology
- Vascular Malformations
- Hepatology
Background:
- Congenital intrahepatic shunts are rare pediatric vascular anomalies with undefined treatment protocols.
- Symptomatic congenital intrahepatic shunts present significant clinical challenges in children.
Observation:
- A retrospective case series analyzed 10 children with symptomatic congenital intrahepatic shunts treated via transcatheter embolization.
- The cohort included arteriovenous shunts (n=7), arterioportal shunts (n=2), and portosystemic shunts (n=1).
- Presentations ranged from congestive heart failure to severe anemia.
Findings:
- Transcatheter embolization resulted in successful symptom resolution in most children.
- Two deaths occurred in the arteriovenous shunt group due to liver dysfunction and abdominal compartment syndrome.
- One child with an arterioportal shunt required liver transplantation.
Implications:
- Interventional embolization offers a less invasive alternative to surgical ligation or hepatic resection for pediatric intrahepatic shunts.
- Complex shunt morphology may limit embolization efficacy, highlighting liver transplantation as a potential alternative.
- This study contributes to establishing treatment strategies for rare pediatric vascular liver lesions.
Background:
Congenital intrahepatic shunts in children are rare and precise treatment strategies have not been established.
Objective:
The purpose of this study was to present our experience with transcatheter embolization in a descriptive case series of congenital intrahepatic shunts in children.
Materials And Methods:
We retrospectively studied 10 children with symptomatic congenital intrahepatic shunts who were treated with embolization at our institute between January 2008 and December 2014.
Results:
Seven children had arteriovenous shunts in association with hepatic hemangiomas, two had arterioportal shunts and one had portosystemic shunts. The major presentations were congestive heart failure and severe anemia in the groups with arteriovenous and arterioportal shunts, respectively. Following embolization, two children died in the arteriovenous group, one from progressive liver dysfunction and the other from abdominal compartment syndrome. One child in the arterioportal group required liver transplantation after initial embolization. With mean post-procedure follow-up of 15 months (range 4-54 months), all the remaining children were well, with resolution of the symptoms.
Conclusion:
Interventional embolization provides an alternative to surgical ligation or hepatic resection in children with clinically significant intrahepatic shunts. For lesions with complex morphology, embolization may be inadequate and liver transplantation might be the only therapeutic option.
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