Management of acute intra-abdominal hemorrhage in ruptured hepatoblastoma with transarterial embolization using calibrated gelfoam particles.

This brief report aims to evaluate the treatment outcome of transarterial embolization in ruptured hepatoblastoma complicated with acute intra-abdominal hemorrhage. Three children (mean age 6 years) with high-risk hepatoblastoma presented with rupture and acute intra-abdominal hemorrhage. In addition to aggressive fluid resuscitation and blood product support, super-selective embolization of the arteries with active bleeding or pseudoaneurysm was performed using calibrated gelfoam particles, with a technical success rate of 100%. Hemodynamic status and hemoglobin level were normalized in all patients within 2 days postembolization. The 30-day survival rate was 100%. No major complication was detected apart from mild elevation of alanine transaminase.

Embolisation of an aneurysmal high-flow renal arteriovenous fistula in a paediatric patient: simultaneous arterial and venous approach.

BACKGROUND: A large aneurysmal renal arteriovenous fistula (AVF) can cause hypokalaemic hypertension due to activation of renin-aldosterone system due to steal effect from renal parenchyma. In comparison to nephrectomy, endovascular embolisation of renal AVF is minimally invasive and can be nephron sparing, thus preserving renal function. However, such embolisation is technically challenging and can be associated with high risk of embolic migration. CASE PRESENTATION: We present a case of successful embolisation of a large aneurysmal renal AVF in a 11-year-old girl. The AVF was initially treated with coil embolization via transarterial route, resulting in partial migration of coil into inferior vena cava. After removal of the migrated coil via transvenous snaring, coils were deployed simultaneously via transarterial and transvenous routes to prevent migration. AVF flow dampened but residual flow persisted at 1 month follow up. A second embolization session with additional coil deployment and N-butyl cyanoacrylate (NBCA) injection resulted in successful occlusion of the AVF. At 3 months follow up, the girl's blood pressure and serum potassium level have normalized without need of antihypertensive agent or potassium supplements. CONCLUSION: Endovascular embolisation can be an effective nephron sparing treatment for large aneurysmal renal AVF. This is particularly important in paediatric patients as most renal function can be preserved with their expected longer life span. Risk of coil migration can be controlled by simultaneous transarterial and transvenous deployment. Complete occlusion of AVF can be aided by additional use of NBCA.

Percutaneous ultrasound-guided renal biopsies in a paediatric population: comparison of coaxial and non-coaxial techniques using 18-gauge core biopsy needles.

BACKGROUND: Percutaneous ultrasound-guided biopsy is performed in paediatric patients for evaluation of diffuse renal parenchymal disease. When compared with the non-coaxial technique, the coaxial technique has the advantages of obtaining multiple tissue cores via a single capsular puncture and post-biopsy tract embolisation. OBJECTIVES: To compare the coaxial and non-coaxial techniques of percutaneous ultrasound (US)-guided biopsy of native kidney parenchyma in children and adolescents with renal disease. MATERIALS AND METHODS: We retrospectively identified consecutive patients who underwent percutaneous US-guided renal biopsy using an 18-gauge core biopsy needle from July 2019 to July 2021 in a single tertiary paediatric nephrology centre. Focal renal tumour biopsy and transplant kidney biopsy were excluded. The total glomerular yield, specimen adequacy, complication rate and procedural time between the coaxial and non-coaxial groups were compared. RESULTS: There were 34 percutaneous US-guided renal biopsies: 22 using a coaxial technique and 12 using a non-coaxial technique. The total median glomerular yield obtained was higher in the coaxial group (coaxial=37.9; non-coaxial=22.2; P=0.02). No statistically significant difference was noted between specimen adequacy (coaxial=100%; non-coaxial=91.7%; P=0.35). While no statistically significant difference was detected for overall complication rates (coaxial=13.6%; non-coaxial=41.7%; P=0.09), the coaxial group had a lower rate of haemorrhagic complications (coaxial=4.5%; non-coaxial=41.7%; P=0.01). One patient in the non-coaxial group had post-biopsy haemorrhage requiring embolisation. The procedural time was shorter in the coaxial group (coaxial=26.3 ± 7.0 min; non-coaxial=51.3 ± 11.5 min; P<0.001). CONCLUSION: Percutaneous US-guided renal biopsy in children using the coaxial technique has significantly higher total glomerular yield, shorter procedural time and fewer haemorrhagic complications, compared to biopsies using the non-coaxial technique.