title: Chemotherapy and surgical approach with repeated endovascular embolizations: safe interdisciplinary treatment for kasabach-merritt syndrome in a small baby.
abstract: BACKGROUND
  Kasabach-Merritt syndrome (KMS) is a life-threatening disease. We describe a combined medical and multistep, endovascular embolization that was successfully performed with surgery.
  
  
  METHODS
  A 40-day-old female baby was referred because of an infiltrating pelvic mass. Blood tests showed severe anemia and thrombocytopenia with consumptive coagulopathy. The clinical aspect was pathognomonic for KMS. Administration of steroids and chemotherapy were started and coagulation parameters were normalized with tumor volume regression. Three months later, elective surgical treatment became possible, and dissection and ligature of the left internal iliac artery and sacral artery were performed. The main arterial supply of the mass was embolized with Spongostan®. Two months later, a second hybrid approach was adopted for embolization of the main vascular supply of the tumor occupying the left thigh. Via a third contralateral hybrid femoral approach and under fluoroscopy, selective catheterization of the left profunda femoris artery was performed. The arterial feeder of the tumor, localized at the left gluteus, was seen on a CT scan 2 months later and was embolized with Onyx-18.
  
  
  CONCLUSIONS
  Chemotherapy and a tailored hybrid approach comprising repeated endovascular embolizations seem to be a safe treatment in cases of unresectable and life-threatening tumors in small babies.
authors.affiliation: Unit of Pediatric Surgery, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy.
authors.forename: Ghassan
authors.initials: G
authors.lastname: Nakib
authors.affiliation: Department of Internal Medicine, University of Pavia, Pavia, Italy ; Department of Internal Medicine, University of Pavia, Pavia, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Calcaterra
authors.affiliation: Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Quaretti
authors.affiliation: Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors.forename: Lorenzo Paolo
authors.initials: LP
authors.lastname: Moramarco
authors.affiliation: Division of Vascular Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Bonalumi
authors.affiliation: Unit of Pediatric Surgery, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Brunero
authors.affiliation: Unit of Pediatric Surgery, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Pelizzo
keywords: Endovascular embolization; Kaposiform hemangioendothelioma; Kasabach-Merritt syndrome; Onyx-18