Transumbilical embolization of hepatic arteriovenous malformation in a neonate with heart failure

Abstract

A newborn infant presented with severe heart failure due to a large hepatic arteriovenous malformation (AVM). Umbilical artery (UA) access was safely used for immediate diagnosis and for embolization.

Transumbilical Arterial Access for Embolization of a Hepatic Vascular Tumor in a Critically Ill Premature Neonate

“…However, if catheterized, the artery will remain patent and can serve as vascular access for interventional procedures. 1 Once the umbilical artery is catheterized, a wire and a catheter can be passed into the anterior division of the iliac artery and then the aorta and eventually to the location of interest. 1 Although crucial to survival for many patients, umbilical vascular catheters are not without risk of complications.…”

Hepatic Arteriovenous Malformation in a Preterm Infant With High-Output Cardiac Failure

“…Strategies for management of HAVM include supportive pharmacologic therapy of congestive heart failure with digoxin and diuretics, transcatheter embolization, surgical resection, and ligation, and, in cases of diffuse HAVM, possibly liver transplantation. [7][8][9][10][11] Surgical intervention is typically reserved for more simple and smaller HAVM which can be resected and has a high mortality risk in critically ill infants. The transarterial approach depending on HAVM composition can be a stop gap measure to curative.…”

Percutaneous coil embolisation of congenital hepatic arteriovenous malformations in two patients with congenital heart disease and review of the literature

“…Surgical ligation of hepatic artery has also been described by some [22,24]. We used transcatheter approach through femoral artery for coil embolisation of AVM, though trans-umbilical approach has also been described by Costa and colleagues [17]. All of the studies have described acceptable results with the occlusion of AVM and resolution of the symptoms.…”

“…Retrospectively thinking, we believe that an AVM should be suspected in a patient who has relatively high systemic saturation for a single ventricle physiology, as in our first case. A keen review of the literature has also confirmed CHF as one of the main presenting feature in majority of the studies [12][13][14][15][16][17][18][19][20]. Other uncommon modes of presentation are portal hypertension [16,20,21], abdominal pain, mass, ischemia or distension [16,[19][20][21][22][23][24], primary pulmonary hypertension [25] and bleeding episodes [26].…”

“…Antenatal diagnosis of a hepatic AVM has already been reported [18]. Postnataly a hepatic AVM can present during neo-natal period [12,14,15,17,20,25,27,28] or during infancy [6,12,13,19]. It can also present during childhood [21] especially in the setting of hereditary hemorrhagic talengiectasia [29,30] or even during adult life [20,23,24,26].…”