LIVER-TRANSPLANTATION AS DEFINITIVE THERAPY FOR COMPLICATIONS AFTER ARTERIAL EMBOLIZATION FOR HEPATIC MANIFESTATIONS OF HEREDITARY HEMORRHAGIC TELANGIECTASIA

Experience with hepatic artery embolization for the treatment of sympt omatic hepatic arteriovenous malformations (AVMs) in Rendu-Osler-Weber disease is limited. We report 2 cases of hepatic AVMs that caused mes enteric angina-like symptoms that were treated with embolization. Both patients developed parenchymal and bile duct necrosis, intrahepatic b ilomas, and refractory biliary sepsis, subsequently leading to liver f ailure, We hypothesize that the pathophysiological cause of biliary ne crosis in this setting is similar to that which occurs in the setting of hepatic artery thrombosis of the liver allograft, Progressive liver failure in these patients was treated successfully by liver transplan tation. Liver transplantation offers definitive therapy by removing th e source of ongoing sepsis, restoring normal liver function, and elimi nating the intrahepatic AV shunt, (C) 1998 by the American Association for the Study of Liver Diseases.