Intrahepatic Arteriovenous Fistulas between the Hepatic Artery and Portal Vein

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

“…This is in marked contrast to systemic arteriovenous shunts, which are a well recognised cause of high output cardiac failure. Foley has artributed this difference to the presence of the hepatic sinusoids lying between the vascular lesion and the right heart, which impose a significant restriction on flow [12]. An alternative explanation is that fistulae between the hepatic artery and portal vein present earlier in their natural history due to the adverse effects of portal hypertension, even when the flow through the fistula is still relatively modest.…”

“…It has been demonstrated that some small arterio-portal fistulae can regress spontaneously [12]. However, those shunts which are producing portal hypertension tend to persist and require treatment.…”

Hepatic Arterioportal Fistulae: Two Case Reports and Review of the Literature

“…In a prospective study, Okuda et al showed that 5.4% of 93 patients had evidence of an arterio portal fistula on hepatic angiography 3 days to 4 weeks after a percutaneous liver biopsy [6]. Many of the fistulae that are acquired through trauma spontaneously close with time, especially if they are small [3,5,9]. In addition to trauma, arterio portal fistulae can also develop from the rupture of a hepatic artery aneurysm into a portal vein or from a focal liver lesion such as a tumor [10].…”

“…There have been a small number of cases reported since it was first described in 1892 by Sachs [1][2][3][4][5][6][7]. These fistulae can cause significant morbidity and mortality as a result of the portal hypertension, but unlike cirrhosis, are potentially curable.…”

Developmental intrahepatic shunts of childhood: radiological features and management

“…They may be diffuse or solitary; the former is always congenital in origin [17], whereas the latter are usually acquired. It is possible that apparent isolated lesions represent a dominant shunt and that selective devascularisation leads to unmasking of other arterioportal fistulae (see case 18). Malabsorption and failure to thrive are the commonest presenting features with portal hypertension developing later.…”