title: Multimodal management of endangering hepatic hemangioma: impact on transplant avoidance: a descriptive case series.
abstract: OBJECTIVE
  To examine the results of the multimodal management of patients with endangering hepatic hemangioma associated with systemic compromise.
  
  
  METHODS
  Retrospective descriptive case series of children with endangering hepatic hemangioma managed at our institution between January 1996 and June 2006.
  
  
  RESULTS
  Six children (5 females) presented with endangering hepatic hemangioma with systemic effects during the index time period. Mean age at presentation was 1.9 months (range, 2 days to 4 months). All patients received medical treatment, and all patients also underwent hepatic embolization, with a median number of procedures of 2 (range, 1-6). Two patients died, one of sepsis and one of progressive liver failure in a child presenting with advanced liver disease owing to neonatal hemochromatosis that was unrecognized at the time. The remaining 4 patients all recovered and were discharged. With mean postprocedure follow-up of 2.11 years (range, 0-6.2 years), all remain well.
  
  
  CONCLUSIONS
  Multimodal management of endangering hepatic hemangioma is a strategy that deserves consideration in the management of these patients. Although the strategy requires further evaluation as to its safety and efficacy, the procedure has the potential to decrease the need for liver transplantation because of treatment failures in this population.
authors.affiliation: Division of General Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Haley
authors.initials: H
authors.lastname: Draper
authors.forename: Ivan R
authors.initials: IR
authors.lastname: Diamond
authors.forename: Michael
authors.initials: M
authors.lastname: Temple
authors.forename: Philip
authors.initials: P
authors.lastname: John
authors.forename: Vicky
authors.initials: V
authors.lastname: Ng
authors.forename: Annie
authors.initials: A
authors.lastname: Fecteau
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006391:Hemangioma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use*
chemical_list: D000305:Adrenal Cortex Hormones; D014750:Vincristine