Hybrid technique coil embolisation for intrahepatic arterioportal fistula in a cat: case report

Abstract

Case summaryA 13-month-old, female, mixed breed, 4.0 kg cat was referred with a 6 month history of decreased appetite, loss of vigour and intermittent vomiting. Physical examination revealed no cyanosis or wasting, and no audible heart murmur was auscultated. Blood profile revealed mild anaemia and mildly elevated postprandial serum ammonia (109 µg/dl). Abdominal ultrasonography revealed dilation of an intrahepatic portal vein branch and an intrahepatic aneurysm, with splenomegaly and ascites. Hepatic arteriovenous fistula/hepatic artery–portal vein fistula with multiple acquired portosystemic shunts was strongly suspected. Medical control was achieved using antibiotics, liver-protecting agents, a low-protein diet and blood transfusions. However, because medical treatment proved ineffective, coil embolisation was performed on day 11, using a hybrid approach via the mesenteric vein. Subsequent follow-up showed good appetite, with no signs of diarrhoea or ascites. Abdominal ultrasonography revealed that the mosaic pattern around the site of coil placement in the portal vein branch had improved and pulsatility had disappeared.Relevance and novel informationIntrahepatic arterioportal fistula involves a circulatory shunt between the hepatic artery and the hepatic or portal vein within the liver, and may be congenital or acquired. Both forms have been reported in humans, but most cases in cats have been congenital. Few reports have described treatment methods or prognosis in cats. We report here that coil embolisation using a hybrid approach is a procedure offering easy, effective treatment by blocking hepatofugal blood flow.

CT features of extrahepatic arterioportal fistula in two cats

“…Depending on the location of the anomalous connection with the portal vein, they are divided into two groups: IHAPF and EHAPF. In veterinary medicine, EHAPFs are extremely rare (Legendre et al 1976, Uemura et al 2016. There is a single report of EHAPF in a dog (White et al 2015) but to our knowledge, there have not been any reports in cats.…”

“…In human medicine, the most common type is intrahepatic and is caused by cirrhosis, trauma or as a complication of an abdominal interventional procedures (Guzman et al 2006). In veterinary medicine, only four cases of IHAPF have previously been reported in cats (Legendre et al 1976, McConnell et al 2006, Uemura et al 2016) and, as far as we know, EHAPF has not previously been described in cats.…”

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

“…Recently, TAE has been considered the preferable treatment because of its low invasiveness and success in some cases, both in animals and humans. [ 21 , 22 ] The goal of embolization is not only to perform selective fistula closure but also to preserve the adjacent normal vasculature, which mandates characterization of the collateral sources of the blood supply to the hepatic segments. Materials that are used for embolization include coils, glue, alcohol, and detachable balloons.…”

Feline abdominal ultrasonography: what’s normal? what’s abnormal? Hepatic vascular anomalies

“…The prevalence of acquired portosystemic shunting in cats as a result of portal hypertension is low and only occasional reports exist. 35-42 This may be at least in part attributable to the relatively low prevalence of cirrhosis in this species, which is a common cause of acquired shunts in the dog. 39 Acquired shunts have been reported to occur in cats in association with several conditions including hepatic fibrosis, 39,41 arterioportal fistulae, 37,43 portal vein thrombosis 37 and chronic diaphragmatic herniation, 40 and also as a sequela to surgical attenuation of a congenital PSS.…”

“…Abdominal ultrasonography was performed on two cats and in both cases revealed ascites and dilation of an intrahepatic portal vein branch containing turbulent pulsatile flow on colour Doppler images. 37,42 In one of the cats, an enlarged coeliac artery could be followed with ultrasound from its origin at the aorta to its communication with the dilated portal vein branch. 37 Doppler interrogation of this cat revealed hepatofugal pulsatile flow of abnormally high speed within the main portal vein, which was dilated.…”