Korean J Pediatr.  2011 Apr;54(4):169-175. 10.3345/kjp.2011.54.4.169.

Selective embolization of the internal iliac arteries for the treatment of intractable hemorrhage in children with malignancies

• Bae SH
• Han DK
• Baek HJ
• Park SJ
• Chang NK
• Kook H
• Hwang TJ

• KMID: 2284370
• DOI: http://doi.org/10.3345/kjp.2011.54.4.169

Abstract

PURPOSE
Acute internal hemorrhage is an occasionally life-threatening complication in pediatric cancer patients. Many therapeutic approaches have been used to control bleeding with various degrees of success. In this study, we evaluated the efficacy of selective internal iliac artery embolization for controlling acute intractable bleeding in children with malignancies.
METHODS
We retrospectively evaluated the cases of 6 children with various malignancies (acute lymphoblastic leukemia, acute myelogenous leukemia, chronic myelogenous leukemia, T-cell prolymphocytic leukemia, Langerhans cell histiocytosis, and rhabdomyosarcoma), who had undergone selective arterial embolization (SAE) of the internal iliac artery at the Chonnam National University Hwasun Hospital between January 2004 and December 2009. SAE was performed by an interventional radiologist using Gelfoam(R) and/or Tornado(R) coils.
RESULTS
The patients were 5 boys and 1 girl with median age of 6.9 years (range, 0.7-14.8 years) at the time of SAE. SAE was performed once in 4 patients and twice in 2, and the procedure was unilateral in 2 and bilateral in 4. The causes of hemorrhage were as follows: hemorrhagic cystitis (HC) in 3 patients, procedure-related internal iliac artery injuries in 2 patients, and tumor rupture in 1 patient. Initial attempt at conservative management was unsuccessful. Of the 6 patients, 5 (83.3%) showed improvement after SAE without complications.
CONCLUSION
SAE may be a safe and effective procedure for controlling acute intractable hemorrhage in pediatric malignancy patients. This procedure may obviate the need for surgery, which carries an attendant risk of morbidity and mortality in cancer patients with critical conditions.

Keyword

Therapeutic embolization; Pediatric patient; Neoplasms

MeSH Terms

Child
Cystitis
Embolization, Therapeutic
Hemorrhage
Histiocytosis, Langerhans-Cell
Humans
Iliac Artery
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Leukemia, Myeloid
Leukemia, Prolymphocytic, T-Cell
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Retrospective Studies
Rupture