Arterioportal Fistulas in Liver Transplant Recipients

Saad, Wael E.A.

doi:10.1055/s-0032-1312571

Cited by 17 publications

(20 citation statements)

References 18 publications

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“…Transarterial coil embolisation is the treatment of choice for APFs. Interventional radiology reduces morbidity and can be performed repeatedly with reduced cost 9. Although this patient did not present clinical signs of portal hypertension such as ascites and upper GI bleeding, he had a large, central and extrahepatic fistula, with portal hypertension that possibly caused the formation of bleeding telangiectasias in the mesentery territory.…”

Section: Discussionmentioning

confidence: 85%

Arterioportal fistula after partial gastrectomy treated with coil embolisation

2019

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Arterioportal fistulas are a rare complication of abdominal interventions. They can remain asymptomatic for a long time and manifest with symptoms of portal hypertension. We present the case of a 65-year-old man admitted to the emergency room with increasing fatigue and melena. He had a history of partial gastrectomy with Billroth II reconstruction 40 years earlier for peptic ulcer perforation. On physical examination, he was pale and presented a machinery-type murmur in the epigastric area. Blood tests revealed iron deficiency anaemia of 5.6 g/dL. During hospitalisation, he required several blood transfusions and maintained melenas. An abdominal CT angiography showed a fusiform aneurysm of the left gastric artery draining to the venous portal-splenic confluent. He was successfully treated with transarterial coil embolisation of the left gastric artery aneurysm. The correct diagnosis of arterioportal fistulas can be very challenging, whereas the standard treatment with coil embolisation offers a low morbidity resolution of symptoms.

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Section: Discussionmentioning

confidence: 85%

Arterioportal fistula after partial gastrectomy treated with coil embolisation

2019

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“…The current case describes an example of a Type II fistula, defined as an acquired large central fistula, resulting in an expanding PVA. APFs are not uncommon in liver transplant recipients; in post-transplant patients undergoing hepatic angiography, the incidence of APFs has been reported as high as 5.4% [6]. However, in a retrospective audit of 1992 cadaveric and living donor liver transplant recipients performed over a 13-year period, only 0.2% were found to have hemodynamically significant APFs resulting in liver function test abnormalities, suggesting that the majority of APFs do not cause adverse sequelae [7].…”

Section: Discussionmentioning

confidence: 99%

Arterial-portal fistula treated with hepatic arterial embolization and portal venous aneurysm stent-graft exclusion complicated by type 2 endoleak

Bremer

Lokken

Gaba

et al. 2019

Radiology Case Reports

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Intrahepatic arterioportal fistulas may be complicated by portal hypertension. An associated portal venous aneurysm (PVA) may impinge upon adjacent structures or rupture. We present a 65-year-old man with an intrahepatic Intrahepatic arterioportal fistula and 6.4 × 5.8 cm right portal vein aneurysm extending within 0.4 cm of the hepatic margin, associated with pain concerning for impending rupture. The PVA was refractory to transarterial embolization due to recruitment of arterial collaterals. Therefore, it was additionally excluded from the portal vein with a 12 mm × 9.5 cm venous stent graft. Although endovascular therapy thrombosed the aneurysm and improved symptoms, it was complicated by a type 2 endoleak into the PVA.

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“…TAE for an APF is safe and effective overall; however, in some cases, especially in liver transplantation patients, there are multiple feeding arteries, seen in up to 20% to 25% of APF cases. [ 23 ] Smaller APFs were usually ignored or concealed on the initial CT and DSA scans. Embolizing the main feeding artery may expose the secondary feeding vessels, and 3-dimensional reconstruction of the blood vessels is sensitive to show the communication of APFs.…”

Section: Discussionmentioning

confidence: 99%

A traumatic hepatic artery pseudoaneurysm and arterioportal fistula, with severe diarrhea as the first symptom

et al. 2018

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Rationale:Hepaticarterioportal fistula (APF) is a rare cause of portal hypertension and gastrointestinal hemorrhage, and presents as abnormal communication between the hepatic artery and portal vein. Percutaneous liver biopsy is a main iatrogenic cause of AFP. However, non-iatrogenic, abdominal, trauma-related APF is rarely reported.Patient concerns:A 29-year-old man presenting with severe, watery diarrhea was transferred to our hospital, and his condition was suspected to be acute gastroenteritis because he ate expired food and suffered a penetrating abdominal stab wound 5 years ago. After admission, the patient suffered from hematemesis, hematochezia, ascites, anuria, and kidney failure, and he developed shock.Diagnoses:The patient was finally diagnosed as a traumatic hepatic artery pseudoaneurysm and APF.Interventions:This patient was treated with emergency transarterial embolization using coils. Since a secondary feeding vessel was exposed after the first embolization of the main feeding artery, a less-selective embolization was performed again.Outcomes:During the 6-month follow-up period, the patient remained asymptomatic.Lessons:A penetrating abdominal stab wound is a rare cause of hepatic APFs, and occasionally leads to portal hypertension, the medical history and physical examination are the most important cornerstones of clinical diagnosis. Interventional radiology is essential for the diagnosis and treatment of an APF.

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Arterioportal Fistulas in Liver Transplant Recipients

Cited by 17 publications

References 18 publications

Arterioportal fistula after partial gastrectomy treated with coil embolisation

Arterioportal fistula after partial gastrectomy treated with coil embolisation

Arterial-portal fistula treated with hepatic arterial embolization and portal venous aneurysm stent-graft exclusion complicated by type 2 endoleak

A traumatic hepatic artery pseudoaneurysm and arterioportal fistula, with severe diarrhea as the first symptom

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