Arterioportal Fistulas (APF) in Liver Tumors: Prognosis in Relation to Treatment

Abstract

Prognosis of 16 patients with hepatic tumors and angiographically proven arterioportal fistulas was analysed in relation to treatment. Six patients received only conservative therapy; they all died of variceal bleeding in the course of two months after angiography. Hepatic resection was performed in four patients; three of them are still alive 13-52 months later including two free of both the tumor and portal hypertension. Hepatic artery embolization was carried out in six patients. All of them died in 2-36 months after the procedure, but only two from gastroesophageal hemorrhage.It is concluded that prognosis of arterioportal fistulae in liver neoplasms is poor due to hyperkinetic portal hypertension and following variceal bleeding. Hepatic resection of both the tumor and the fistula is the treatment of choice. In unresectable cases hepatic artery embolization will decrease the risk of variceal hemorrhage.

Hepatic Arterioportal Fistula: A Curable Cause of Portal Hypertension in Infancy

“…Erosion of splanchnic artery aneurysms into the portal circulation is another relatively common cause of fistulae [7] and many of these will occur in extrahepatic locations. Other causes of arterioportal fistulae are rare, and include liver turmours [8], hepatic amyloidosis [9] [3], and there has been only one subsequent case reported from Berlin [4]. The case reported here is also remarkable in that surgical treatment has been successful in eliminating the source of portal hypertension in the long term.…”

“…Those with small shunts may present as incidental findings at surgery for other reasons, as a chance finding at post mortem examination, or they may be detected in asymptomatic patients when a bruit and thrill are noted over the liver. When there is a clinical presentation it is most commonly characterised by the development of ascites or haemorrhage from oesophageal varices, as a result of portal hypertension [3,[8][9][10]]. An unusual manifestation of portal hypertension with which some of these fistulae have presented is mesenteric vascular congestion, resulting in symptoms of abdominal pain and diarrhoea [1,11].…”