Prevalence, presentation, and endovascular management of hemodynamically or clinically significant arterio‐portal fistulae in living and cadaveric donor liver transplant recipients

Saad, Wael E.A.; Lippert, Allison; Arslan, Bülent; Kumer, Sean C.; Waldman, David L.; Turba, Ulku C.; Schmitt, Timothy M.; Matsumoto, Alan H.; Angle, John F.

doi:10.1111/j.1399-0012.2011.01547.x

Cited by 15 publications

(38 citation statements)

References 18 publications

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“…Post-discharge, there was complete resolution of the ascites. Pediatric APFs are rare, usually associated with hepatic trauma or needle intervention (2). Mieles et al reported a 12-month-old with an APF following a segmental liver transplantation, successfully managed with transcatheter coil embolization (1).…”

Section: Dear Editormentioning

confidence: 99%

Unique presentation and endovascular management of arterio‐portal fistula after liver transplant

Salsamendi

Pereira

Tekin

et al. 2015

Pediatric Transplantation

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Section: Dear Editormentioning

confidence: 99%

Unique presentation and endovascular management of arterio‐portal fistula after liver transplant

Salsamendi

Pereira

Tekin

et al. 2015

Pediatric Transplantation

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“…1,8,9 This is despite the fact that liver transplant recipients undergo numerous percutaneous procedures (liver biopsies and percutaneous transhepatic cholangiograms) and are under constant imaging surveillance. [1][2][3] This may shed light as to the pathogenesis of hemodynamically significant APFs. [1][2][3]10 Etiology and Pathogenesis APFs are considered arterial injuries leading to a connection between the high-pressure hepatic artery and an adjacent lower-pressure portal vein branch.…”

mentioning

confidence: 98%

“…[1][2][3] This may shed light as to the pathogenesis of hemodynamically significant APFs. [1][2][3]10 Etiology and Pathogenesis APFs are considered arterial injuries leading to a connection between the high-pressure hepatic artery and an adjacent lower-pressure portal vein branch. [1][2][3]8,[11][12][13][14][15] APFs are believed to be a product of percutaneous transhepatic procedures such as percutaneous liver biopsies and percutaneous transhepatic cholangiograms (PTCs) with or without percutaneous biliary drain placement, hence the presumed etiology of iatrogenic vascular injury.…”

mentioning

confidence: 98%

Arterioportal Fistulas in Liver Transplant Recipients

Saad

2012

Semin intervent Radiol

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Arterioportal fistulas (APFs) are classified into intrahepatic (>75% of all reported) and extrahepatic (<25% of all reported ). Anecdotally, investigators are more likely to report more sensational cases (typically extrahepatic APFs), so the actual prevalence of intrahepatic APFs is probably much higher (likely >90% of APFs). All reported APFs in liver transplant recipients have been intrahepatic. Hemodynamically significant APFs in liver transplant recipients are rare, occurring in 0.2%; however, APFs (hemodynamically significant or not) are not uncommonly seen in hepatic angiograms of liver transplant recipients (up to 5.4% of hepatic arteriograms in transplants). Interestingly, hemodynamically significant APFs warranting endovascular treatment are reported more commonly in the literature in native compared with transplanted livers (n >280?300 versus n?=?13, respectively). This article discusses APFs that are specific to liver transplant recipients; their incidence, etiology, pathogenesis, natural history, clinical presentation, and endovascular management are discussed in detail.

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“…Doppler ultrasonography is particularly useful because it has high sensitivity and specificity for hemodynamically significant hepatic artery to portal vein fistulas. [17][18][19] Treatment of this rare condition is mainly endovascular, with surgery reserved for complex cases. 17,20,21 Embolization is also challenging as the actual fistulous communication is very short and liver allografts are relatively hypoperfused and hence susceptible to ischemia.…”

Section: Hepatic Artery To Portal Vein Fistulasmentioning

confidence: 99%

“…Attention to proper technique and the proper embolic agent is important. 17,19 For hepatic artery to portal vein fistulas, the embolic agent should be selected according to the size of the vascular communication and flow. In larger fistulas with high flow, there is risk of distal migration and portal vein thrombosis.…”

Section: Hepatic Artery To Portal Vein Fistulasmentioning

confidence: 99%

Untitled

2015

Exp Clin Transplant

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Objectives: Recipients of liver transplant are surviving longer as both the surgical procedure and postsurgical care have improved. Despite improvements, serious complications from the procedure remain that significantly affect patient outcome and may result in retransplant. Refractory ascites is one complication, occurring in about 5.6% of transplant recipients. Management of refractory ascites after liver transplant presents a challenge to the multidisciplinary team caring for these patients. Materials and Methods:We discuss approaches to the diagnosis and treatment of refractory ascites after liver transplant, based on a literature review, with a primary focus on vascular causes. These approaches are illustrated by case examples highlighting our experiences at an academic tertiary medical center. We propose a clinical practice algorithm for optimal endovascular treatment of refractory ascites after liver transplant. Results: The cornerstone of refractory ascites care is diagnosis and treatment of the cause. Vascular causes are not infrequently encountered and, if not treated early, are associated with graft loss and high morbidity and mortality and are major indications for retransplant. For patients with recurrent disease or graft rejection needing large volume paracentesis, the use of a transjugular intrahepatic portosystemic shunt may serve as a bridge to more definitive treatment (retransplant), although it may not be as effective for managing ascites as splenic artery embolization, arguably underused, which is emerging as a potential alternative treatment option. Conclusions: A multidisciplinary strategy for the diagnosis and care of patients with refractory ascites after liver transplant is crucial, with endovascular treatment playing an important role. The aim is for this document to serve as a concise and informative reference to be used by those who may care for patients with this rare yet serious diagnosis.

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Prevalence, presentation, and endovascular management of hemodynamically or clinically significant arterio‐portal fistulae in living and cadaveric donor liver transplant recipients

Abstract: Significant APF are a rare diagnosis (0.2% of transplants). Coil embolization is a safe and effective treatment option for APF in transplants.

Cited by 15 publications

References 18 publications

Unique presentation and endovascular management of arterio‐portal fistula after liver transplant

Unique presentation and endovascular management of arterio‐portal fistula after liver transplant

Arterioportal Fistulas in Liver Transplant Recipients

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