A Case Report of Endovascular Embolization for Giant Congenital Hemangioma with Arteriovenous Fistula in A Neonate

Abstract

Background: Congenital hemangioma (CH) is a vascular tumor that develops during fetal life. Although most CHs are benign, those associated with high-flow arteriovenous fistulas (AVFs) can lead to life-threatening complications such as high-output cardiac failure and severe pulmonary hypertension. Case Presentation: We report a male preterm infant (birth weight: 2.8 kg) with a giant CH and AVF on the left forehead, confirmed by transcranial Doppler and magnetic resonance angiography (MRA). The patient rapidly developed high-output cardiac failure and respiratory failure. Despite maximal medical therapy, his condition deteriorated. A multidisciplinary team deemed surgical resection prohibitively high-risk, and transcatheter arterial embolization was selected as the primary intervention. Intervention and Outcome: On day 11 of life, successful embolization was performed via a right femoral approach under general anesthesia. Despite a femoral artery diameter <1 mm, vascular access was achieved using a pediatric needle and Seldinger technique. Angiography confirmed a high-flow AV shunt, which was embolized using a combination of detachable and free coils. Post-procedurally, pulmonary artery pressure decreased from 77 mmHg to 42 mmHg, and the ductus arteriosus shunt converted from right-to-left to bidirectional. The patient was weaned from mechanical ventilation on day 8 post-procedure. Four months later, radical resection confirmed CH with AV malformation. At one-year follow-up, there was no neurological deficit or recurrence. Conclusion: Transcatheter embolization is a life-saving treatment for neonates with CH and high-flow AVF when surgery is not feasible. This case highlights the feasibility of complex endovascular interventions in extremely low-weight infants and underscores the value of multidisciplinary management.