Clinical outcome of transfemoral embolisation in patients with arteriovenous malformations of the liver in hereditary haemorrhagic telangiectasia (Weber-Rendu-Osler disease)

Abstract

(Gut 1998;42:123-126)

Liver transplantation as definitive therapy for complications after arterial embolization for hepatic manifestations of hereditary hemorrhagic telangiectasia

“…Conversely, mesenteric angina was the indication for treatment of hepatic AVMs in a single case in the literature. 27 In these 2 cases, a diagnosis of mesenteric angina was supported by classic symptoms and angiographic evidence of the siphoning of blood flow away from the SMA circulation through large collaterals into the liver and through the large intrahepatic shunt. Both patients had improvement of symptoms after embolization that corresponded with angiographic improvement of the steal syndrome.…”

“…The incidence of liver involvement in HHT is unknown, but it appears the lesion is uncommon, with fewer than 80 cases reported in the literature. 7,9,11,[13][14][15][20][21][22][23][24][25][26][27][28][29] From the literature, the most common indication for therapeutic intervention for symptomatic hepatic involvement is highoutput cardiac failure. Conversely, mesenteric angina was the indication for treatment of hepatic AVMs in a single case in the literature.…”

“…34,35 In fact, a meta-analysis of the literature shows a mortality rate of nearly 20%. 1,13,15,[20][21][22][23][24][25][26][27] Reported complications of HA embolization include inadvertent pulmonary embolization, reflux migration of particles to distant sites, parenchymal necrosis, liver failure, and death. To minimize the risk for developing these complications, Whiting et al 21 injected small amounts of radiolabeled Ivalon particles of various sizes before therapeutic embolization to visualize whether the particles remained in the liver or migrated to distant sites.…”

“…For symptomatic patients, embolization of the feeding vessels is an attractive treatment strategy, but it is based on limited data in the literature and may be associated with significant mortality. 13,15,[20][21][22][23][24][25][26][27] We describe 2 patients with HHT and large hepatic AVMs who presented with symptoms characteristic of intestinal angina and weight loss caused by stealing of blood flow from the mesenteric circulation by the large intrahepatic shunt. Transcatheter angiographic embolization was performed in an attempt to reduce the shunt fraction and relieve symptoms.…”

Hereditary hemorrhagic teleangiectasia: the topical problems of diagnostics and surgical treatment

“…Согласно международным рекомендациям эмболизация АВМ выполняется при наличии противопоказаний к трансплантации печени и сопряжена с большим уровнем послеопе рационных осложнений и летальности. Тем не ме нее, по данным A. Chavan и соавт., смертность после эмболизации АВМ печени сопоставима со смертно стью после пересадки печени, однако сопряжена с меньшим количеством осложнений [71][72][73]. Ради кальным методом лечения печеночных АВМ явля ется пересадка печени, а основными показаниями к ней -тяжелая сердечная недостаточность, билиар ная ишемия, портальная гипертензия, отсутствие эффекта от эмболизации.…”