Hepatic Arterioportal Fistulas: A Retrospective Analysis of 97 Cases

Abstract

Background and Aims: Hepatic arterioportal fistulas (HAPFs) are abnormal shunts or aberrant functional connections between the portal venous and the hepatic arterial systems. Detection of HAPFs has increased with the advances in diagnostic techniques. Presence of HAPFs over a prolonged period can aggravate liver cirrhosis and further deteriorate liver function. However, the underlying causes of HAPFs and the treatment outcomes are now well characterized. This study aimed to summarize the clinical characteristics of patients with HAPFs, and to compare the outcomes of different treatment modalities. Methods: Data of 97 patients with HAPFs who were admitted to the Second Xiangya Hospital between January 2010 and January 2020 were retrospectively reviewed. Demographic information, clinical manifestations, underlying causes, treatment options, and short-term outcomes were analyzed. Results: The main cause of HAPF in our cohort was hepatocellular carcinoma (78/97, 80.41%), followed by cirrhosis (10/97, 10.31%). The main clinical manifestations were abdominal distention and abdominal pain. Treatment methods included transcatheter arterial embolization (n=63, 64.9%), surgery (n=13, 13.4%), and liver transplantation (n=2, 2.1%); nineteen (19.6%) patients received conservative treatment. Among patients who underwent transcatheter arterial embolization, polyvinyl alcohol, lipiodol combined with gelatin sponge, and spring steel ring showed comparable efficacy. Conclusions: Hepatocellular carcinoma and cirrhosis are common causes of HAPFs. Transcatheter arterial embolization is a safe and effective method for the treatment of HAPFs, and polyvinyl alcohol, lipiodol combined with gelatin sponge, and spring steel ring showed comparable efficacy in our cohort.

Spontaneous hepatic arterioportal fistula in extrahepatic portal vein obstruction: Combined endovascular and surgical management

“…In a retrospective analysis of 97 cases of HAPF, two patients had "portal spongiform transformation." However, further details of imaging appearances and causes of HAPF in these two patients were not described [6]. Of these two patients, one was treated with transcatheter embolization while the other patient did not receive any specific treatment.…”

“…These are rarely congenital. More commonly, they are secondary to trauma, iatrogenic procedures (e.g., liver biopsy, transhepatic biliary drainage, surgery, liver transplant), cirrhosis, and hepatic neoplasms (most commonly hepatocellular carcinoma) [5,6,10,11]. Spontaneous development of HAPF is uncommon.…”

“…Hepatic arterioportal fistulae (HAPF) are uncommon vascular lesions that can develop due to abnormal communication between the hepatic artery and portal vein. HAPF might be congenital or secondary to iatrogenic causes (e.g., post liver biopsy, transhepatic biliary drainage, surgery, and post-liver transplant), trauma, hepatic cirrhosis, and hepatic neoplasms [5,6]. Macroscopic HAPFs represent high-flow vascular lesions in which hepatic artery blood flow bypasses hepatic sinusoids to drain into the portal circulation, leading to pre-sinusoidal portal hypertension [5].…”

Hepatic Arterial Infusion Chemotherapy Combined with Lenvatinib and PD-1 Inhibitors for Managing Arterioportal Shunt in Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: A Retrospective Cohort Study

“…In the progression of HCC, tumors often infiltrate hepatic portal vein, creating direct communication between hepatic artery and portal vein, leading to the development of APS. 29 Severe APS exacerbates complications related to portal hypertension, such as intractable ascites and esophageal varices, and hinders chemoembolization. 6–9 …”

Successful coil embolization of post-hepatectomy arterioportal fistula that reduced ascites and improved liver function

“…HAPF is often treated by transcatheter inflow arterial embolization, which is a minimally invasive procedure [5] , [6] , [7] . Causes of HAPF include congenital anomalies, trauma, malignancies, rupture of visceral aneurysm, and iatrogenic complications (biliary drainage, percutaneous hepatic puncture) [8] , [9] , [10] , [11] , [12] . However, HAPF after hepatectomy is extremely rare, and to our knowledge, there are only two published reports of HAPF after hepatectomy being successfully treated by embolization [ 13 , 14 ].…”