Arterioportal Fistula Research Articles

Embolization of traumatic hemobilia in a child

The management of a case of hemobilia in a child after abdominal trauma is described. Two intrahepatic false aneurysms and an arterioportal fistula in the right lobe of the liver were diagnosed by ultrasound and Doppler and successfully embolized during the diagnostic angiogram. Selective angiographic embolization may save the patient an operative procedure and appears to be an acceptable method for primary treatment of this condition in children.

Arterioportal fistulas (APF) in liver tumors: prognosis in relation to treatment.

Prognosis of 16 patients with hepatic tumors and angiographically proven arterioportal fistulas was analysed in relation to treatment. Six patients received only conservative therapy; they all died of variceal bleeding in the course of two months after angiography. Hepatic resection was performed in four patients; three of them are still alive 13–52 months later including two free of both the tumor and portal hypertension. Hepatic artery embolization was carried out in six patients. All of them died in 2–36 months after the procedure, but only two from gastroesophageal hemorrhage. It is concluded that prognosis of arterioportal fistulae in liver neoplasms is poor due to hyperkinetic portal hypertension and following variceal bleeding. Hepatic resection of both the tumor and the fistula is the treatment of choice. In unresectable cases hepatic artery embolization will decrease the risk of variceal hemorrhage.

Intrahepatic Arterioportal Fistula after Blunt Hepatic Trauma

Intrahepatic arterioportal fistula (APF) was found in five out of 65 consecutive patients following blunt hepatic trauma. In four patients the fistula was located peripherally and the blood flow was small. These fistulas closed spontaneously within 3 months. However, a centrally located fistula with early visualization of the trunk of the portal vein persisted in one patient and necessitated transcatheter embolization. The APF in this patient caused portal dilatation which was detectable by CT scan. We conclude that spontaneous closure can be expected when an APF is located peripherally and the shunt flow is small, while centrally located APF with large flow require active treatment, preferably by transcatheter embolization. An APF detectable by CT scan suggests the need of intervention.

A case of intrahepatic portal vein aneurysm with arterioportal fistula and severe portal hypertension

A case of intrahepatic portal vein aneurysm with arterioportal fistula and severe portal hypertension

Arterioportal Fistulas: Twelve Cases

During the last 20 years, we encountered 14 arterioportal fistulas in 12 patients. Gastrointestinal hemorrhage or mesenteric artery insufficiency were the most frequent conditions found after the diagnosis. Arterioportal arterial fistulas were congenital in two cases and acquired in 10; seven of these 10 were iatrogenic. One patient had three successive and different sites of arterioportal fistula. The fistula originated from a branch of the celiac axis in nine cases, the superior mesenteric artery in three, and the inferior mesenteric artery in two. One patient died of massive anal bleeding before any treatment was possible. Eight fistulas were treated surgically and five by arterial embolization. After treatment there was no early mortality, while hemorrhagic and ischemic complications regressed in all cases. Three hemorrhagic recurrences were observed in patients with preexisting cirrhosis (two cases) or by recurrence of a congenital arteriovenous fistula (one case). Closure of symptomatic arterioportal fistula is justified. The choice of the most appropriate method for each patient should be discussed between the surgeon and interventional radiologist on a case by case basis.

Traumatic Superior Mesenteric Artery—Portal Vein Fistula

An interesting and rare case of traumatic superior mesenteric artery-to-portal vein arteriovenous fistula is presented. Initial operative control of the bleeding superior mesenteric artery injury required ligation of the superior mesenteric artery at its origin to prevent exsanguination in an extremely unstable patient with multiple injuries. Early postoperative visceral arteriography documented ligation of the superior mesenteric artery with a proximal superior mesenteric artery-to-portal vein arteriovenous fistula. Percutaneous catheter embolization of the arteriovenous fistula was undertaken successfully at this time. Superior mesenteric artery ligation was surprisingly well tolerated. Major arterioportal fistulas require treatment to prevent long-term complications of intestinal ischemia, portal hypertension, and cirrhosis. Although traditional treatment involves ligation of the arteriovenous fistula and arterial bypass, percutaneous embolization is becoming a viable alternative. Arteriography remains the cornerstone of diagnosis and treatment planning.

Hepatoportal arteriovenous fistula: Morphologic features studied after orthotopic liver transplantation

A 51-year-old woman underwent orthotopic liver transplantation because of a small-duct primary sclerosing cholangitis associated with chronic ulcerative colitis and a hepatoportal arteriovenous fistula. Arteriograms before liver transplantation and specimen arteriograms revealed a convolution of arteries in the right hepatic lobe which communicated with a massively dilated and partly thrombosed portal vein branch. The lesion was probably the result of a previous liver biopsy. Microscopic examination of the fistula and of specimens taken at a distance from the fistula showed prominent intimal fibroplasia of portal vein branches. The vascular changes were so severe that hepatic artery and portal vein branches closely resembled each other on routine sections. We are unaware of such a finding in other conditions and therefore believe that recognition of the described vascular abnormalities in liver biopsy specimens should lead pathologists to comment that an arterioportal fistula might be present.

Invited discussion of “lack of portal‐venous hypertension after an arterioportal fistula in the rat,” by milagros benito, M.D., PH.D., Juan Gonzalez Del Pino, M.D., PH.D., Lucia Hernandez, M.D., and Juan Diez Pardo, M.D.

MicrosurgeryVolume 10, Issue 3 p. 202-203 Original Article Invited discussion of “lack of portal-venous hypertension after an arterioportal fistula in the rat,” by milagros benito, M.D., PH.D., Juan Gonzalez Del Pino, M.D., PH.D., Lucia Hernandez, M.D., and Juan Diez Pardo, M.D. Sun Lee M.D., Sun Lee M.D. San Diego Microsurgical Institute and Training Center at Mercy Hospital, San Diego, CASearch for more papers by this authorMilbhor D'silva M.D., Milbhor D'silva M.D. San Diego Microsurgical Institute and Training Center at Mercy Hospital, San Diego, CASearch for more papers by this author Sun Lee M.D., Sun Lee M.D. San Diego Microsurgical Institute and Training Center at Mercy Hospital, San Diego, CASearch for more papers by this authorMilbhor D'silva M.D., Milbhor D'silva M.D. San Diego Microsurgical Institute and Training Center at Mercy Hospital, San Diego, CASearch for more papers by this author First published: 1989 https://doi.org/10.1002/micr.1920100311Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume10, Issue31989Pages 202-203 RelatedInformation

Lack of portal-venous hypertension after an arterioportal fistula in the rat.

The hepatic effects of an end-to-side arteriovenous fistula between the right renal artery and the portal vein were studied in rats. Fifty rats underwent surgery and were studied 3, 12, 24 weeks and 1 year later; Another 15 rats were used as controls. Rats did not have any portohepatic abnormality. Portal and caval pressure were measured, and the liver was evaluated histologically. No statistically significant differences were achieved between the control portal (10.37 +/- 0.29 cm H2O) and vena cava pressures (1.22 +/- 0.19 cm H2O) and those of the experimental groups. The overall liver architecture remained unchanged. A progressive enlargement of the intrahepatic portal and hepatic veins was noted. No hypertrophy of the fibrous tissue into the portal triads, hypertrophy of the muscularis of the portal vein radicals, or wall sclerotic thickening was seen. The forward overflow compensatory mechanisms are discussed.

Fatal hemorrhage from an arterio-portal-peritoneal fistula after percutaneous liver biopsy

Exsanguinating hemorrhage complicated a percutaneous needle biopsy in a 64-yr-old woman with a probable collagen vascular disease. Angiography performed before Gelfoam embolization demonstrated a hepatic arterio-portal venous-peritoneal fistula, a lesion not previously described, to be a cause of the hemorrhage. Although surgery remains the treatment of choice, the role of selective hepatic arteriography and Gelfoam embolization in patients with serious hemorrhage who are poor surgical risks needs evaluation.

Portal Hypertension Secondary to Congenital Arterioportal Fistula

SummaryAn infant boy with severe portal hypertension developed failure to thrive and malabsorption. Clinical findings and ultrasonography suggested the presence of an arteriovenous shunt, and hepatic angiography confirmed the diagnosis and outlined the anatomy of the vascular malformation, which was an intrahepatic arterioportal fistula. Ligature of the hepatic artery gave excellent results as demonstrated by disappearance of portal hypertension and malabsorption and subsequent growth catch‐up. Portal hypertension

Hepatic lesions associated with intrahepatic arterioportal fistulae in dogs.

Seven cases of hepatic arterioportal fistulae in young dogs (mean age 6 months) are described. All cases were presumed to be congenital in origin. The onset of clinical signs, which frequently included gastrointestinal and neurological disturbances, was usually sudden. All dogs had clinical evidence of portal hypertension in the form of ascites, and all developed multiple extrahepatic portacaval venous shunts consequential to portal hypertension. The neurological disturbances were likely the result of portacaval shunting. The arterial and venous vessels involved in the fistulae had markedly altered wall structure. Hepatic regions adjacent to the fistulae frequently evidenced marked bile duct proliferation. Hepatic parenchymal atrophy, relative collapse of distributing portal veins, dilatation of hepatic arterial branches and proliferation of hepatic arterioles were seen throughout the liver; these changes closely resembled those present with portacaval shunting in the absence of hepatic arterioportal fistulae. The importance of recognizing that hepatic arterioportal fistulae and multiple extrahepatic portacaval shunts usually coexist and separately influence the morphological appearance of the liver is stressed.

Dynamic CT features of hepatic abscesses.

Forty hepatic abscesses were examined with dynamic computed tomography (CT). A "double target sign," consisting of a hypodense central area surrounded by first a hyperdense ring and then a hypodense zone, seems to be highly suggestive of abscess formation. In 12 cases, the hepatic parenchyma surrounding the lesion demonstrated transient hyperdensity after contrast injection, possibly due to localized hepatic venous obstruction secondary to acute hepatic inflammation. This is similar to the appearance of an arterioportal fistula.

Large spontaneous intrahepatic arterioportal fistula demonstrated by rapid sequential computed tomographic scan

Abstract A huge spontaneous intrahepatic arterioportal shunt with regurgitation through the portal vein trunk was demonstrated by computed tomography and confirmed by angiography in 2 patients with liver cirrhosis. Rapid sequential computed tomographic scanning was very useful in the diagnosis and follow-up after arterial embolization. Early visualization of the portal vein and increased attenuation in the ipsilateral lobe bearing the fistula were demonstrated in 1 case, and the same findings were also demonstrated by computed tomography and angiography in the other case.

Large spontaneous intrahepatic arterioportal fistula demonstrated by rapid sequential computed tomographic scan: Report of two cases

A huge spontaneous intrahepatic arterioportal shunt with regurgitation through the portal vein trunk was demonstrated by computed tomography and confirmed by angiography in 2 patients with liver cirrhosis. Rapid sequential computed tomographic scanning was very useful in the diagnosis and follow-up after arterial embolization. Early visualization of the portal vein and increased attenuation in the ipsilateral lobe bearing the fistula were demonstrated in 1 case, and the same findings were also demonstrated by computed tomography and angiography in the other case.

Angiographic studies of the totally arterialized rat liver.

Twenty-three angiographies were performed in 20 rats with a totally arterialized liver. The arterialization was obtained by the construction of an end-to-side portacaval shunt (PCS) and an arteriovenous (AV) fistula between the left gastric artery and the portal stump. Microsurgical technique was necessary because of the small diameter of the AV fistula (0.5 mm). The angiographic examinations showed an AV fistula patency rate of 70% and a PCS rate of 100%. A successively increasing diameter of the fistula with dilation of the intrahepatic portal vessels was demonstrated in the rats with a patent arterioportal fistula. Tortuous and irregular vessels were also observed. All these signs suggest an overarterialization which developed despite the use of a very small AV fistula. None of the three rats examined histologically had cirrhosis of the liver. Further research is needed to attempt to avoid or minimize the deleterious effects of overarterialization of the portal tree, while utilizing the advantages of a dual liver blood supply in patients with decompressive PCS.

Metastatic hepatic neoplasms: angiographic features of portal vein involvement.

Hepatic metastases produce a spectrum of angiographic alterations of the portal vein that mimicks that of primary liver neoplasms. In 11 patients with varied primary malignancies, hepatic arteriograms revealed seven instances of opacification of the portal vein from arterioportal shunting, two cases of intraluminal tumor thrombus, and two cases with intrahepatic portal vein occlusion. Another patient with liver metastases developed an arterioportal fistula following percutaneous liver biopsy. Although uncommon, metastatic involvement of the portal vein is not necessarily indicative of a poor prognosis since one patient's arterioportal shunting resolved following intraarterial chemotherapy infusion and tumor regression.

Intrahepatic vascular lesions following nonsurgical percutaneous transhepatic bile duct intubation.

Hepatic angiography was performed following nonsurgical percutaneous transhepatic intubation of the bile ducts in patients with extrahepatic cholestasis. Vascular lesions of the liver (aneurysm, hematoma, arterioportal venous fistula, arteriohepatic venous fistula) were demonstrated in 27 of 83 patients. No clinical complications were observed in 22 of these cases. One patient with an arterioportal venous fistula developed marked hemobilia necessitating blood transfusion. In four patients with severe hemorrhage from an intrahepatic aneurysm, transcatheter embolization was performed. Two of these patients died within 72 h because of liver insufficiency.

Arteriography in hepatic trauma.

The arteriographic findings associated with hepatic trauma were studied in 87 patients. Arterial occlusion, marked extravasation, slight hemorrhage, pseudo-tumor, subcapsular hematoma, arteriobiliary fistula, and arterioportal fistula were seen either in isolation or randomly grouped. Differentiation of these lesions is discussed. Apparent disagreements between the anatomical appearances and the radiographic images at times arise, and a complete knowledge of arterial anatomy is necessary to avoid underestimation of the size or nature of the lesion.

Traumatic intrahepatic arterioportal fistula.

Abstract A case of traumatic intrahepatic arterioportal fistula successfully treated surgically is reported. Pre-operative angiography is essential for precise anatomical location and a definitive diagnosis.