Hereditary hemorrhagic telangiectasia: effective protocol for embolization of hepatic vascular malformations--experience in five patients.
OBJECTIVE
To develop a hepatic artery embolization protocol and investigate its efficacy in a prospective study treating patients with hereditary hemorrhagic telangiectasia and predominant hepatic involvement.


METHODS
One man and four women with hereditary hemorrhagic telangiectasia presented with symptoms of high-output heart failure, abdominal angina, or severe portal hypertension. The hepatic arteries were embolized in stages in three to five sessions at 1- to 15-week intervals. After peripheral embolization with polyvinyl alcohol particles, proximal arteries were embolized with coils. Computed tomography and assessment of cardiac output were performed before and after therapy and at the end of follow-up (median, 25 months; range, 12-55 months).


RESULTS
After embolization, analgesics and antiemetics were necessary for a median of 5 and 2 days, respectively. Other than ischemic cholangitis (one patient), no complications were observed. The mean cardiac output decreased significantly (P < .05) from 14.2 L/min to 8.0 L/min. Symptoms of high-output heart failure, abdominal angina, and portal hypertension resolved in all patients. Seven months after embolization, one patient died of postoperative sepsis after an unsuccessful surgical attempt to create a portacaval shunt. Delayed recurrence of symptoms was not noted in the other patients.


CONCLUSIONS
In symptomatic patients with hereditary hemorrhagic telangiectasia and predominant hepatic involvement, embolization of the hepatic arteries in stages is well tolerated by the patients and results in good clinical improvement at midterm follow-up.
Chavan
A
A
Department of Diagnostic Radiology, Hannover Medical School, Germany.
Galanski
M
M
Wagner
S
S
Caselitz
M
M
Schlitt
H J
HJ
Gratz
K F
KF
Manns
M
M
D000328:Adult; D001165:Arteriovenous Malformations / Q000150:complications / Q000628:therapy*; D002985:Clinical Protocols; D004621:Embolization, Therapeutic; D005260:Female; D006499:Hepatic Artery / Q000002:abnormalities*; D006503:Hepatic Veins / Q000002:abnormalities*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications / Q000628:therapy*