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Title: Utilization of non-conventional access in the management of consumptive coagulopathy in infants with vascular tumor
e-poster Number: EPOS 52
Category: e Poster
Author Name: Dr. Shoban Haridass
Institute:
Co-Author Name:
Abstract :
Consumptive coagulopathy in vascular tumor can be mild, transient or severe, rapidly progressive. Milder version of coagulopathy are frequently associated with congential hemangiomas, where as the severe variety is encountered in Kapsoiform hemangioendothelioma (KHE) and tufted angioma. The later entity is termed as 'Kasabach Meritt phenomenon (KMP)'. KMP occurs due to entrapment of platelet in large vascular tumors and platelet activation leading to thrombocytopenia, hypofibrinogenemia and microangiopathic anemia. Endovascular management has shown good results in patients that are refractory to medical management to overcome this life threatening event. In infants, considering the smaller size of the vessels, femoral arterial access is commobly utilized. In this poster, two patients with consumptive coagulopathy, successfully managed by non CFA access are discussed.
Patient 1 - Direct tumoral puncture in a 3 month old infant with biopsy proven KHE with KMP. The tumor in the lumbar region was directly accessed with few LP needles and 20 percent glue was injected under fluoro guidance. On immediate follow up, there was steady rise in platelet and fibrinogen count. Also on 2 year follow up, there was significant reduction in size of the tumor.
Patient 2 - Umbilical arterial access in a 3 days old neonate with giant hepatic hemangioma with consumptive coagulopathy and symptoms due to mass effect. The hepatic arterial branches feeding the tumor was selectively cannulated and embolized using PVA particles and gelfoam. On immediate follow up, there was good improvement in platelet and fibrinogen count.
IR management of KMP and non-KMP consumptive coagulopathy has shown promising results when the first line medical management has failed or when the response is slow. As these tumors are frequently seen in infants, possiblity of alternative vascular access like umbilical artery or direct tumor puncture to be considered as they are easy to perform and complications related to femoral arterial access can be avoided.
