Complications and clinical outcome of hepatic artery embolisation in patients with hereditary haemorrhagic telangiectasia.

Abstract

BACKGROUND:

Hepatic artery embolisation (HAE) in patients with hereditary haemorrhagic telangiectasia (HHT) is controversial because of the associated complications and unproven long-term benefit. We present our results in 20 such patients over a time span of 17 years.

METHODS:

Staged HAE was performed using polyvinyl alcohol (PVA) particles and coils. Complications, clinical symptoms and cardiac output were assessed before and after therapy as well as at the end of follow-up (median 92 months, range 26-208 months).

RESULTS:

Two patients died within 30 days following HAE (10 %). Four further deaths resulted from causes unrelated to HAE. Ischaemic cholangitis, cholecystitis and focal hepatic necrosis with biliary sepsis necessitated re-intervention in four patients. In all but one patient, clinical symptoms resolved with mean cardiac output falling from 11.84 ± 3.22 l/min pre-treatment to 8.13 ± 2.67 l/min at the end of follow-up (P < 0.001). One patient required liver transplantation for de novo symptoms of portal hypertension 4 years after primary symptoms had been cured by HAE.

CONCLUSION:

The 30-day mortality of HAE in patients with HHT is 10 %. The rate of complications requiring re-intervention is 20 %. Clinical response at long-term follow-up is satisfactory.

• Authors: Ajay Chavan, Lars Luthe, Michael Gebel, Hannelore Barg-Hock, Hans Seifert, Rudolph Raab, Timm Kirchhoff, B Schmuck
• Journal: European radiology (Eur Radiol) Vol. 23 Issue 4 Pg. 951-7 (Apr 2013) ISSN: 1432-1084 [Electronic] Germany
• PMID: 23111819 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Polyvinyl Alcohol

Topics

• Adult
• Aged
• Biliary Tract Diseases (diagnosis, etiology)
• Embolization, Therapeutic (adverse effects, methods)
• Female
• Hepatic Artery
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Polyvinyl Alcohol (adverse effects, therapeutic use)
• Telangiectasia, Hereditary Hemorrhagic (therapy)
• Treatment Outcome