Multiple collaterals to hepatic infantile hemangioendotheliomas and arteriovenous malformations: effect on embolization.

Hemangioendotheliomas and arteriovenous malformations (AVMs) of the liver often cause congestive heart failure in babies, but embolization of the hepatic artery is not always effective. Six newborns and infants (four with hemangioendotheliomas and two with AVMs) underwent abdominal aortography, hepatomesenteric arteriography, and angiography of arterial and portal collateral vessels prior to embolization of the hepatic artery for heart failure (n = 5) and portal hypertension (n = 1). In addition, extrahepatic arteries were embolized in one patient and a portal vein branch in another. Extrahepatic arterial collaterals from the superior mesenteric, intercostal, phrenic, and adrenal arteries were seen in five patients; portal vein connections, in two patients. Embolization was therapeutically most effective in the baby with the least collateral supply and in the two patients in whom arterial collaterals or portal venous connections were embolized. Angiographic documentation and possibly embolization of collateral flow is required to improve treatment planning and success in these severely ill patients.