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Pediatric Radiology

Published in:

01-04-2016 | Original Article

Interventional embolization of congenital intrahepatic shunts in children

Authors: Lin Wu, Lu Zhao, Ying Lu, Lan He, Xihong Hu

Published in: Pediatric Radiology | Issue 4/2016

Abstract

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.

Paley MR, Farrant P, Kane P et al (1997) Developmental intrahepatic shunts of childhood: radiological features and management. Eur Radiol 7:1377–1382CrossRefPubMed

Gallego C, Miralles M, Marín C et al (2004) Congenital hepatic shunts. Radiographics 24:755–772CrossRefPubMed

Draper H, Diamond IR, Temple M et al (2008) Multimodal management of endangering hepatic hemangioma: impact on transplant avoidance: a descriptive case series. J Pediatr Surg 43:120–125CrossRefPubMed

Christison-Lagay ER, Burrows PE, Alomari A et al (2007) Hepatic hemangiomas: subtype classification and development of a clinical practice algorithm and registry. J Pediatr Surg 42:62–67CrossRefPubMed

Kassarjian A, Zurakowski D, Dubois J et al (2004) Infantile hepatic hemangiomas: clinical and imaging findings and their correlation with therapy. AJR Am J Roentgenol 182:785–795CrossRefPubMed

Warmann S, Bertram H, Kardorff R et al (2003) Interventional treatment of infantile hepatic hemangioendothelioma. J Pediatr Surg 38:1177–1181CrossRefPubMed

Zenzen W, Perez-Atayde AR, Elisofon SA et al (2009) Hepatic failure in a rapidly involuting congenital hemangioma of the liver: failure of embolotherapy. Pediatr Radiol 39:1118–1123CrossRefPubMed

Kuroda T, Hoshino K, Nosaka S et al (2014) Critical hepatic hemangioma in infants: recent nationwide survey in Japan. Pediatr Int 56:304–308CrossRefPubMed

Kuroda T, Kumagai M, Nosaka S et al (2011) Critical infantile hepatic hemangioma: results of a nationwide survey by the Japanese Infantile Hepatic Hemangioma Study Group. J Pediatr Surg 46:2239–2243CrossRefPubMed

10.

Norton SP, Jacobson K, Moroz SP et al (2006) The congenital intrahepatic arterioportal fistula syndrome: elucidation and proposed classification. J Pediatr Gastroenterol Nutr 43:248–255CrossRefPubMed

11.

Bogert JN, Potter DD, Crow S et al (2011) An unusual presentation of a congenital intrahepatic arterioportal fistula in an infant with Down syndrome. J Pediatr Surg 46:252–255CrossRefPubMed

12.

Karnak I, Cil BE, Akay H et al (2009) Congenital intrahepatic arterioportal fistula: an unusual cause of portal hypertension treated by coil embolization in an infant. Eur J Pediatr Surg 19:251–253CrossRefPubMed

13.

Ozyer U, Kirbas I, Aytekin C et al (2008) Coil embolization of a congenital intrahepatic arteriotal fistula: increasing experience in management. Pediatr Radiol 38:1253–1256CrossRefPubMed

14.

Kumar N, de Goyet Jde V, Sharif K et al (2003) Congenital, solitary, large, intrahepatic arterioportal fistula in a child: management and review of the literature. Pediatr Radiol 33:20–23CrossRefPubMed

15.

Raghuram L, Korah IP, Jaya V et al (2001) Coil embolization of a solitary congenital intrahepatic hepatoportal fistula. Abdom Imaging 26:194–196CrossRefPubMed

16.

Agarwala S, Dutta H, Bhatnagar V et al (2000) Congenital hepatoportal arteriovenous fistula: report of a case. Surg Today 30:268–271CrossRefPubMed

17.

Teplisky D, Tincani EU, Lipsich J et al (2012) Congenital arterioportal fistulas: radiological treatment and color Doppler US follow-up. Pediatr Radiol 42:1326–1332CrossRefPubMed

18.

Tannuri AC, Tannuri U, Lima FR et al (2009) Congenital intrahepatic arterioportal fistula presenting as severe undernutrition and chronic watery diarrhea in a 2-year-old girl. J Pediatr Surg 44:e19–e22CrossRefPubMed

19.

Sutcliffe R, Mieli-Vergani G, Dhawan A et al (2008) A novel treatment of congenital hepatoportal arteriovenous fistula. J Pediatr Surg 43:571–573CrossRefPubMed

20.

Fuchs J, Warmann SW, Sieverding L et al (2010) Impact of virtual imaging procedures on treatment strategies in children with hepatic vascular malformations. J Pediatr Gastroenterol Nutr 50:67–73CrossRefPubMed

21.

Blanc T, Guerin F, Franchi-Abella S et al (2014) Congenital portosystemic shunts in children: a new anatomical classification correlated with surgical strategy. Ann Surg 260:188–198CrossRefPubMed

22.

Stringer MD (2008) The clinical anatomy of congenital portosystemic venous shunts. Clin Anat 21:147–157CrossRefPubMed

23.

Kanazawa H, Nosaka S, Miyazaki O et al (2015) The classification based on intrahepatic portal system for congenital portosystemic shunts. J Pediatr Surg 50:688–695CrossRefPubMed

24.

Park JH, Cha SH, Han JK et al (1990) Intrahepatic portosystemic venous shunt. AJR Am J Roentgenol 155:527–528CrossRefPubMed

Title: Interventional embolization of congenital intrahepatic shunts in children
Authors: Lin Wu
Lu Zhao
Ying Lu
Lan He
Xihong Hu
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Radiology / Issue 4/2016
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-015-3497-3

ACC 2024 Congress

Springer Medicine

Interventional embolization of congenital intrahepatic shunts in children

Abstract

Background

Objective

Materials and methods

Results

Conclusion

ACC 2024 Congress

Springer Medicine

Abstract

Background

Objective

Materials and methods

Results

Conclusion

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