Fatal Outcome after Embolotherapy for Hepatic Arteriovenous Malformations of the Liver in Two Patients with Hereditary Hemorrhagic Telangiectasia
2000; Elsevier BV; Volume: 11; Issue: 7 Linguagem: Inglês
10.1016/s1051-0443(07)61800-4
ISSN1535-7732
AutoresJohn H. Whiting, Joshua R. Korzenik, Franklin J. Miller, Jeffrey S. Pollack, Robert I. White,
Tópico(s)Sharing Economy and Platforms
ResumoPATIENTS with hepatic arteriovenous malformation (AVM) associated with hereditary hemorrhagic telangiectasia (HHT) present with diverse clinical manifestations ranging from cirrhosis to cholestasis and multiple biliary strictures ( 1 Deviere J Brohee D Hiden M Bourgeois N Hepatic telangiectasia and cirrhosis. J Clin Gastroenterol. 1988; 10: 111-114 Crossref PubMed Scopus (16) Google Scholar , 2 Bernard G Mion F Henry L Plauchu H Paliard P Hepatic involvement in hereditary hemorrhagic telangiectasia: clinical, radiological, and hemodynamic studies of 11 cases. Gastroenterology. 1993; 105: 482-487 PubMed Google Scholar , 3 Guttmacher AE Marchuk DA White Jr, RI Hereditary hemorrhagic telangiectasia. N Engl J Med. 1995; 333: 918-924 Crossref PubMed Scopus (879) Google Scholar , 4 Buscarini E Buscarini L Danesino C et al. Hepatic vascular malformations in hereditary hemorrhagic telangiectasia: Doppler sonographic screening in a large family. J Hepatol. 1997; 26: 111-118 Abstract Full Text PDF PubMed Scopus (93) Google Scholar ). Left-to-right shunting may also lead to abdominal pain, weight loss, high output heart failure, pulmonary hypertension, and encephalopathy ( 5 Michaeli D Ben-Bassat I Miller HI Deutsch V Hepatic telangiectases and portosystemic encephalopathy in Osler-Weber-Rendu disease. Gastroenterology. 1968; 54: 929-932 PubMed Scopus (36) Google Scholar , 6 Radtke WE Smith HC Fulton RE Adson MA Misdiagnosis of atrial septal defect in patients with hereditary telangiectasia (Osler-Weber-Rendu disease) and hepatic arteriovenous fistulas. Am Heart J. 1978; 95: 235-242 Abstract Full Text PDF PubMed Scopus (37) Google Scholar , 7 Bourgeois N Delcour C Deviere J et al. Osler-Weber-Rendu disease associated with hepatic involvement and high output heart failure. J Clin Gastroenterol. 1990; 12: 236-238 Crossref PubMed Scopus (53) Google Scholar , 8 Brohee D Franken P Fievez M et al. High-output right ventricular failure secondary to hepatic arteriovenous microfistulae: selective arterial embolization treatment. Arch Intern Med. 1984; 144: 1282-1284 Crossref PubMed Scopus (47) Google Scholar , 9 Rambusch EG Chavan A Harms CP et al. Hereditary hemorrhagic telangiectasia with hepatic involvement and including gastric vessels: a case report. Vasa. 1996; 25: 352-357 PubMed Google Scholar , 10 Nikolopoulos N Xynos E Vassilakis JS Familial occurrence of hyperdynamic circulation status due to intrahepatic fistulae in hereditary hemorrhagic telangiectasia. Hepato-Gastroenterology. 1988; 35: 167-168 PubMed Google Scholar , 11 Fagel WJ Perlberger R Kauffmann RH Portosystemic encephalopathy in hereditary hemorrhagic telangiectasia. Am J Med. 1988; 85: 858-860 Abstract Full Text PDF PubMed Scopus (23) Google Scholar , 12 Whiting Jr, JH Morton KA Datz FL Patch GG Miller Jr, FJ Embolization of hepatic arteriovenous malformations using radiolabeled and nonradiolabeled polyvinyl alcohol sponge in a patient with hereditary hemorrhagic telangiectasia: case report. J Nucl Med. 1992; 33: 260-262 PubMed Google Scholar ). Therapeutic options reported for symptomatic AVMs include hepatic artery embolization, ligation, or liver transplantation ( 12 Whiting Jr, JH Morton KA Datz FL Patch GG Miller Jr, FJ Embolization of hepatic arteriovenous malformations using radiolabeled and nonradiolabeled polyvinyl alcohol sponge in a patient with hereditary hemorrhagic telangiectasia: case report. J Nucl Med. 1992; 33: 260-262 PubMed Google Scholar , 13 Allison DJ Jordan H Hennessy O Therapeutic embolisation of the hepatic artery: a review of 75 procedures. Lancet. 1985; 1: 595-599 Abstract PubMed Scopus (157) Google Scholar , 14 Derauf BJ Hunter DW Sirr SA Cardella JF Castaneda-Zuniga W Amplatz K Peripheral embolization of diffuse hepatic arteriovenous malformations in a patient with hereditary hemorrhagic telangiectasia. Cardiovasc Intervent Radiol. 1987; 10: 80-83 Crossref PubMed Scopus (41) Google Scholar , 15 Roman CF Cha SD Incarvito J Cope C Maranhao V Transcatheter embolization of hepatic arteriovenous fistula in Osler-Weber-Rendu disease—a case report. Angiology. 1987; 38: 484-488 Crossref PubMed Scopus (32) Google Scholar ). Hepatic artery embolization is assumed to be low risk and of benefit based on favorable results seen in the treatment of hepatomas, liver metastases, and hemangiomas ( 13 Allison DJ Jordan H Hennessy O Therapeutic embolisation of the hepatic artery: a review of 75 procedures. Lancet. 1985; 1: 595-599 Abstract PubMed Scopus (157) Google Scholar , 16 Reading NG Forbes A Nunnerley HB Williams R Hepatic haemangioma: a critical review of diagnosis and management. Quart J Med. 1988; 67: 431-445 PubMed Google Scholar , 17 Hemingway AP Allison DJ Complications of embolization: analysis of 410 procedures. Radiology. 1988; 166: 669-672 Crossref PubMed Scopus (120) Google Scholar ). Although embolization is effective in the treatment of pulmonary AVMs in patients with HHT ( 18 Lee DW White Jr, RI Egglin TK et al. Embolotherapy of large pulmonary arteriovenous malformations: long-term results. Ann Thorac Surg. 1997; 64: 930-939 Abstract Full Text Full Text PDF PubMed Scopus (242) Google Scholar ), successful implementation of this approach for the more complex HHT liver lesions remains unproven. Several previous reports (including ours) support embolization of HHT-related hepatic AVMs ( 8 Brohee D Franken P Fievez M et al. High-output right ventricular failure secondary to hepatic arteriovenous microfistulae: selective arterial embolization treatment. Arch Intern Med. 1984; 144: 1282-1284 Crossref PubMed Scopus (47) Google Scholar , 9 Rambusch EG Chavan A Harms CP et al. Hereditary hemorrhagic telangiectasia with hepatic involvement and including gastric vessels: a case report. Vasa. 1996; 25: 352-357 PubMed Google Scholar , 10 Nikolopoulos N Xynos E Vassilakis JS Familial occurrence of hyperdynamic circulation status due to intrahepatic fistulae in hereditary hemorrhagic telangiectasia. Hepato-Gastroenterology. 1988; 35: 167-168 PubMed Google Scholar , 12 Whiting Jr, JH Morton KA Datz FL Patch GG Miller Jr, FJ Embolization of hepatic arteriovenous malformations using radiolabeled and nonradiolabeled polyvinyl alcohol sponge in a patient with hereditary hemorrhagic telangiectasia: case report. J Nucl Med. 1992; 33: 260-262 PubMed Google Scholar , 13 Allison DJ Jordan H Hennessy O Therapeutic embolisation of the hepatic artery: a review of 75 procedures. Lancet. 1985; 1: 595-599 Abstract PubMed Scopus (157) Google Scholar , 14 Derauf BJ Hunter DW Sirr SA Cardella JF Castaneda-Zuniga W Amplatz K Peripheral embolization of diffuse hepatic arteriovenous malformations in a patient with hereditary hemorrhagic telangiectasia. Cardiovasc Intervent Radiol. 1987; 10: 80-83 Crossref PubMed Scopus (41) Google Scholar , 15 Roman CF Cha SD Incarvito J Cope C Maranhao V Transcatheter embolization of hepatic arteriovenous fistula in Osler-Weber-Rendu disease—a case report. Angiology. 1987; 38: 484-488 Crossref PubMed Scopus (32) Google Scholar , 19 Caselitz M Wagner S Chavan A et al. Clinical outcome of transfemoral embolisation in patients with arteriovenous malformations of the liver in hereditary haemorrhagic telangiectasia (Weber-Rendu-Osler disease). Gut. 1998; 42: 123-126 Crossref PubMed Scopus (64) Google Scholar ). However, the utility, morbidity, and mortality of the procedure has not been critically evaluated. We report the deaths of two patients with HHT after hepatic AVM embolization to treat their high flow-related symptoms.
Referência(s)