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Klompenhouwer AJ, Moelker A, Murad SD, den Hoed CM, Maan R. Portal Embolisation as Treatment of Severe Portal Hypertension Due to Idiopathic Intrahepatic Arterioportal Fistula: A Case Report. J Clin Exp Hepatol 2024; 14:101295. [PMID: 38076444 PMCID: PMC10709512 DOI: 10.1016/j.jceh.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 10/16/2023] [Indexed: 03/03/2025] Open
Abstract
Intrahepatic arterioportal fistula (IAPF) is a rare cause of portal hypertension. Treatment is usually aimed at restoring the normal portal hemodynamics by obliterating the shunt. This report describes a case of idiopathic IAPF with severe portal hypertension complicated by portal enteropathy with vomiting, gastrointestinal hemorrhage and sepsis. The patient was successfully treated with portal embolization.
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Affiliation(s)
- Anne J. Klompenhouwer
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sarwa D. Murad
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- The Erasmus MC Transplant Institute, Rotterdam, The Netherlands
| | - Caroline M. den Hoed
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- The Erasmus MC Transplant Institute, Rotterdam, The Netherlands
| | - Raoel Maan
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- The Erasmus MC Transplant Institute, Rotterdam, The Netherlands
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Cho E, Mitani H, Chosa K, Tomiyoshi H, Baba Y, Awai K. Transportal scleroembolization of hepatic arterioportal fistulas in a patient with portal hypertension: A case report. Radiol Case Rep 2023; 18:3783-3786. [PMID: 37663560 PMCID: PMC10474348 DOI: 10.1016/j.radcr.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/12/2023] [Accepted: 08/02/2023] [Indexed: 09/05/2023] Open
Abstract
We report a rare patient with portal hypertension who presented with esophageal- and gastric varices and refractory ascites due to hepatic arterioportal fistulas. Treatment by transportal scleroembolization using ethanolamine oleate and coils were successful. Pretreatment hepatofugal flow subsequently changed to hepatopetal flow and the symptoms of portal hypertension improved. We describe our endovascular treatment option for addressing hepatic arterioportal fistulas.
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Affiliation(s)
- Etsu Cho
- Department of Radiology, National Hospital Organization Higashihiroshima Medical Center, 513 Saijochojike, Higashihiroshima, Hiroshima 739-0041, Japan
| | - Hidenori Mitani
- Department of Diagnostic Radiology, Hiroshima University Hospital, Minami-ku, Hiroshima Japan
| | - Keigo Chosa
- Department of Diagnostic Radiology, Hiroshima University Hospital, Minami-ku, Hiroshima Japan
| | - Hideki Tomiyoshi
- Department of Radiology, National Hospital Organization Higashihiroshima Medical Center, 513 Saijochojike, Higashihiroshima, Hiroshima 739-0041, Japan
| | - Yasutaka Baba
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Hidaka, Saitama Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Hiroshima University Hospital, Minami-ku, Hiroshima Japan
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3
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Takata H, Makino H, Yokoyama T, Maruyama H, Hirakata A, Ueda J, Yoshida H. Successful surgical treatment for intrahepatic arterioportal fistula with severe portal hypertension: a case report. Surg Case Rep 2019; 5:67. [PMID: 31016545 PMCID: PMC6478780 DOI: 10.1186/s40792-019-0623-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 04/04/2019] [Indexed: 01/09/2023] Open
Abstract
Background Intrahepatic arterioportal fistula (IAPF) is a rare cause of portal hypertension. Interventional radiology (IVR) is generally selected as the first-line therapeutic option. Surgical treatment for IAPF is required in refractory cases of IVR. As the treatment success rate with IVR is high, cases requiring surgical treatment are extremely rare. Case presentation A 54-year-old man was admitted to another hospital complaining of hematemesis due to rupture of the esophageal varices. A computed tomography revealed ascites and arterioportal fistula in the left lobe of the liver. Transcatheter arterial embolization (TAE) was performed to occlude the fistula; however, it could not reach complete occlusion. Thereafter, there were a total of four hematemeses, and six endoscopic variceal ligations were required. The second TAE also failed to reach complete occlusion. He was transferred to our hospital for further treatment. Because liver function was low due to frequent hematemeses and there was also uncontrollable ascites, it was confirmed that hepatectomy could not be performed safely at this time. Therefore, we ligated the left portal branch and ligated and dissected the left gastric vein to decrease portal vein pressure. However, on the 5th day after surgery, the esophageal varices reruptured. As the disappearance of ascites was observed in the postoperative course and the general condition also improved, left hepatectomy was performed to remove IAPF. There was no recurrence of portal hypertension for 1 year and 3 months since hepatectomy. Conclusions This case was difficult to treat with IVR and required surgical treatment. Our experience in the present case suggests that hepatectomy to remove arterioportal fistula was considered effective for improving portal hypertension due to IAPF. However, careful treatment selection according to the patient’s overall condition and clinical course is necessary for IAPF presenting with severe portal hypertension.
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Affiliation(s)
- Hideyuki Takata
- Department of Surgery, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama city, Tokyo, 206-8512, Japan.
| | - Hiroshi Makino
- Department of Surgery, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama city, Tokyo, 206-8512, Japan
| | - Tadashi Yokoyama
- Department of Surgery, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama city, Tokyo, 206-8512, Japan
| | - Hiroshi Maruyama
- Department of Surgery, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama city, Tokyo, 206-8512, Japan
| | - Atsushi Hirakata
- Department of Surgery, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama city, Tokyo, 206-8512, Japan
| | - Junji Ueda
- Department of Surgery, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama city, Tokyo, 206-8512, Japan
| | - Hiroshi Yoshida
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Double-Balloon-Assisted n-Butyl-2-Cyanoacrylate Embolization of Intrahepatic Arterioportal Shunt Prior to Chemoembolization of Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2016; 39:1479-83. [DOI: 10.1007/s00270-016-1377-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
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Kanogawa N, Chiba T, Ogasawara S, Ooka Y, Suzuki E, Motoyama T, Saito T, Sekimoto T, Tawada A, Maruyama H, Yoshikawa M, Yokosuka O. Successful interventional treatment for arterioportal fistula caused by radiofrequency ablation for hepatocellular carcinoma. Case Rep Oncol 2014; 7:833-9. [PMID: 25685134 PMCID: PMC4307006 DOI: 10.1159/000370305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Radiofrequency ablation (RFA) is commonly used as a treatment for small hepatocellular carcinoma (HCC). Although several complications such as intraperitoneal bleeding are often observed after RFA, hepatic arterioportal fistula (APF) is a less frequently occurring complication. In this study, we describe two cases of APF caused by RFA, which was successfully occluded by an interventional approach. Case 1 involved a 68-year-old man with solitary HCC in segment VIII of the liver. Both contrast-enhanced computed tomography and color Doppler sonography indicated an APF between the anterosuperior branch of the right hepatic artery (A8) and the portal branch (P8). Concordant with these findings, digital subtraction angiography (DSA) revealed an APF in segment VIII of the liver. Subsequently, the APF was successfully occluded by transarterial embolization (TAE) using gelatin sponge particles. Case 2 involved a 67-year-old man with solitary HCC in segment VII of the liver. Although he developed obstructive jaundice because of hemobilia after RFA, it was improved by endoscopic nasobiliary drainage and the systemic administration of antibiotics. In addition, color Doppler sonography revealed a disturbed flow of the right branch of the portal vein. Similar to case 1, DSA showed an APF between A8 and P8. The APF was successfully embolized by TAE using microcoils. In conclusion, it appears that the formation of APF should be checked after RFA. It is preferable to treat RFA-induced APF promptly by an interventional approach to avoid secondary complications such as portal hypertension and liver dysfunction.
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Affiliation(s)
- Naoya Kanogawa
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tetsuhiro Chiba
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshihiko Ooka
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Eiichiro Suzuki
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tenyu Motoyama
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoko Saito
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tadashi Sekimoto
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Akinobu Tawada
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hitoshi Maruyama
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masaharu Yoshikawa
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Osamu Yokosuka
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Fluctuating portal velocity tracing with rhythmicity: ultrasonic differential diagnosis and clinical significance. Radiol Oncol 2012; 46:198-206. [PMID: 23077458 PMCID: PMC3472948 DOI: 10.2478/v10019-012-0028-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 01/02/2012] [Indexed: 02/08/2023] Open
Abstract
Background To evaluate the usefulness of the routine sonographic evaluation of the pattern of fluctuate portal velocity tracings and the hepatic veins for the diagnosis of arterioportal fistula (APF) and cardiogenic trans-sinusoidal shunting (CTS). Materials and methods. Color Doppler flow imaging and pulsed-wave Doppler (PW) examinations of the portal vein were performed in 282 subjects. The waveforms of the velocity tracings in the portal main trunk and its branches were determined to infer APF or CTS. Suspected cases of APFs or CTSs were always confirmed by echocardiography, contrast-enhanced ultrasound, computed tomography, or digital subtraction angiography findings. The portal maximum velocity (Vmax), minimum velocity(Vmin), Vmax/Vmin, arterial peak systolic velocity and resistance index, and venous reverse and forward velocities were used to estimate their haemodynamics. Results The waveform of the velocity tracing for the draining portal vein of APF was typically arterial-like or diphase, as indicated by a systolic hepatofugal dwarf peak and a diastolic hepatopetal low flat shape. The flow in the affected portal vein was always hepatofugal in an intrahepatic patient, whereas a hepatopetal flow was observed in an extrahepatic APF patient. The waveform of the velocity tracing for the portal vein of CTS patients, especially its intrahepatic branches, showed a typical hump-like shape with or without a transitory hepatofugal tracing. The PW results displayed an increase in the retrograde phase of the hepatic venous flow with increased velocities in the two phases. Conclusions Portal velocity tracings should be evaluated during routine detecting for APF or CTS, especially in patients with gastrointestinal upsets.
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7
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Ascites caused by arterioportal fistula 15 years after liver biopsy. Clin Gastroenterol Hepatol 2011; 9:e31-2. [PMID: 21070869 DOI: 10.1016/j.cgh.2010.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 10/26/2010] [Accepted: 10/30/2010] [Indexed: 02/07/2023]
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Krishan S, Mcpherson S, Pine J, Hayden J. Current Management of Mesenteric Extrahepatic Arterioportal Fistulas: Report of a Case Treated With a Gastroduodenal Artery Stent Graft and Literature Review. Vasc Endovascular Surg 2009; 44:139-45. [DOI: 10.1177/1538574409347389] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Spontaneous arteriovenous fistulation of a pseudoaneurysm into superior mesenteric vein (SMV) has rarely been reported. We present the case of a 61-year-old woman who presented with a post pancreatic arterioportal fistula (APF) that was successfully managed by stent graft (SG) placement in the gastroduodenal artery (GDA). We also review the published experience of the endovascular management of mesenteric extrahepatic APFs. This review demonstrates the evolution from open surgical to endovascular management for majority of these patients.
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Affiliation(s)
- Sonal Krishan
- Department of Interventional Radiology, The General Infirmary at Leeds, Leeds,
| | - Simon Mcpherson
- Department of Interventional Radiology, The General Infirmary at Leeds, Leeds
| | - James Pine
- Upper Gastrointestinal and Minimally Surgery, The General Infirmary at Leeds, Leeds
| | - Jeremy Hayden
- Upper Gastrointestinal and Minimally Surgery, The General Infirmary at Leeds, Leeds
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9
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Murata S, Tajima H, Nakazawa K, Onozawa S, Kumita S, Nomura K. Initial experience of transcatheter arterial chemoembolization during portal vein occlusion for unresectable hepatocellular carcinoma with marked arterioportal shunts. Eur Radiol 2009; 19:2016-23. [PMID: 19238387 DOI: 10.1007/s00330-009-1349-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 01/19/2009] [Accepted: 01/27/2009] [Indexed: 01/13/2023]
Abstract
The purpose of this study was to assess the clinical effects of transcatheter arterial chemoembolization (TACE) during the corresponding portal vein occlusion (TACE-PVO) in patients with hepatocellular carcinoma (HCC) and marked arterioportal (AP) shunts. This was a prospective, nonrandomized study of TACE-PVO in patients with HCC who had marked AP shunts. The subjects were 21 patients with unresectable HCC and marked AP shunts who underwent shunt embolization with the use of coils and/or gelatin-sponge particles (group A: n = 7) or by TACE-PVO (group B: n = 14). Clinical parameters and data on embolization of AP shunts and on tumor response were assessed prospectively. No major procedure-related complication occurred in either group. Effectiveness of AP-shunt treatment was significantly better in group B than in group A in terms of both immediate results (P = 0.009) and subsequent results (P = 0.028). Tumor response in the therapeutic target area was significantly (P = 0.002) better in group B than in group A. Survival was significantly better in group B than in group A (P = 0.008). TACE-PVO may be a safe and useful therapy for selected patients with unresectable HCC and marked AP shunts.
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Affiliation(s)
- Satoru Murata
- Department of Radiology, Center for Advanced Medical Technology, Nippon Medical School, 1-1-5 Sendagi, Bunkyou-ku, Tokyo, 113-8602, Japan.
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10
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Koc O, Cil BE, Peynircioglu B, Emlik D, Ozbek O. Complementary Use of NBCA with the Amplatzer Vascular Plug for Embolization of a High-Flow Traumatic Hepatic Arteriovenous Fistula. Cardiovasc Intervent Radiol 2009; 32:1105-7. [DOI: 10.1007/s00270-009-9505-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 12/24/2008] [Accepted: 01/06/2009] [Indexed: 10/21/2022]
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11
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Dumortier J, Pilleul F, Adham M, Vochelle V, Hervieu V, Bouffard Y, Valette PJ, Scoazec JY, Boillot O. Severe portal hypertension secondary to arterio-portal fistula: salvage surgical treatment. Liver Int 2007; 27:865-8. [PMID: 17617130 DOI: 10.1111/j.1478-3231.2007.01495.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND Arterio-portal fistulas (APFs) are rare vascular disorders of various origins that can lead to severe portal hypertension. Even if surgery was initially the treatment of choice, more recently, interventional radiological procedures have been considered as the first line therapeutic option. CASE REPORT A man with no history of liver disease was admitted for abdominal pain and distension. Abdominal ultrasonography with Doppler, magnetic resonance imaging and computed tomography (CT) scan showed ascites, splenomegaly and a probable APF between the left branches of both the hepatic artery and portal vein, associated with hepatofugal portal flow. Upper gastrointestinal endoscopy revealed large oesophageal varices without bleeding. A celiac and mesenteric arteriography and a splenic arteriography were performed and confirmed the existence of multiple intrahepatic APFs. The initial treatment consisted of two sessions of percutaneous transcatheter endovascular embolization. Unfortunately, ascites worsened, and the patient did not respond to diuretic treatment. Therefore, a surgical treatment was considered to be the only suitable treatment because of the absence of improvement after embolization procedures. A left hepatectomy with hepatic artery ligation was performed. Clinical evolution was favourable; an improvement of ascites was obtained; control ultrasonography and CT scan disclosed no residual haemodynamic abnormality; and the portal vein was normal with a hepatopedal flow. Currently, 12 months after surgery, the clinical condition of the patient is good. CONCLUSION Percutaneous treatment of portal hypertension by embolizing multiple large APF has been described to be an effective method. Nevertheless, failure of such conservative treatment is possible and must lead to a salvage surgery.
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12
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Matsumoto T, Yamagami T, Kato T, Hirota T, Yoshimatsu R, Nishimura T. Transcatheter arterial embolisation of a ruptured pseudoaneurysm of the lingual artery with n-butyl cyanoacrylate. Br J Radiol 2007; 80:e54-7. [PMID: 17495057 DOI: 10.1259/bjr/61848822] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pseudoaneurysms can arise due to localized arterial wall disruption, owing to various factors such as inflammation, trauma, neoplasm, or surgical procedures. Once ruptured, bleeding can be life-threatening. Thus, a treatment for pseudoaneurysm is necessary. We describe a case of post-surgical ruptured pseudoaneurysm of the lingual artery that was successfully treated by transcatheter embolisation with n-butyl cyanoacrylate (NCBA).
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Affiliation(s)
- T Matsumoto
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan
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Hsu HC, Chen TY, Chiu KW, Huang EY, Leung SW, Huang YJ, Wang CY. Three-dimensional conformal radiotherapy for the treatment of arteriovenous shunting in patients with hepatocellular carcinoma. Br J Radiol 2007; 80:38-42. [PMID: 16971419 DOI: 10.1259/bjr/55395102] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The objective of this study is to evaluate the efficacy of radiotherapy for the treatment of arteriovenous shunting (AVS) in patients with hepatocellular carcinoma (HCC). Between November 1997 and April 2005, 20 HCC patients with AVS were referred to our department for radiotherapy. The radiation was delivered with 10-15 MV X-ray given 5 days per week at 2 approximately 2.5 Gy per fraction. Total doses ranged from 45 to 64 Gy (median dose 60 Gy). The patients were followed up with color Doppler sonography. When non-invasive imaging suggested obliteration, X-ray angiography was performed to verify the results. Four of the 20 AVS proved to be completely obliterated at X-ray angiography in 1.9, 2.8, 1.8 and 2.9 months after radiotherapy. One of the remaining 16 showed obvious regression on Doppler sonography 0.5 months after radiotherapy, but X-ray angiography was not performed to verify the result. Radiation-related hepatic failure did not occur during the follow-up period. In conclusion, radiotherapy is a treatment alternative for AVS in HCC patients and gives patients with poor prognosis the chance to receive further transcatheter arterial embolization.
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Affiliation(s)
- H C Hsu
- Department of Radiation Oncology, Chang Gung Memorial Hospital-Kaohsung Medical Center, 123, Ta-Pei Road, Niao Sung Hsian, Kaohsiung 807, Taiwan.
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14
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Yamagami T, Kanda K, Kato T, Hirota T, Nishida K, Yoshimatsu R, Matsumoto T, Nishimura T. Embolisation of proximal anastomotic pseudoaneurysm developing after surgical repair of abdominal aortic aneurysm with a bifurcated graft with n-butyl cyanoacrylate. Br J Radiol 2006; 79:e193-5. [PMID: 17213297 DOI: 10.1259/bjr/97367208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report a 60-year-old man who after undergoing surgical repair of an abdominal aortic aneurysm with a bifurcated graft subsequently developed a proximal anastomotic pseudoaneurysm, which was successfully treated by embolisation with n-butyl cyanoacrylate.
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Affiliation(s)
- T Yamagami
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-chyo, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan.
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15
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Tasar M, Gulec B, Bozlar U, Saglam M, Ugurel MS, Ucoz T. Intrahepatic arterioportal fistula and its treatment with detachable balloon and transcatheter embolization with coils and microspheres. Clin Imaging 2006; 29:325-30. [PMID: 16153538 DOI: 10.1016/j.clinimag.2004.11.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2004] [Revised: 10/01/2004] [Accepted: 11/15/2004] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although intrahepatic arterioportal fistula (APF) due to acquired or congenital causes are infrequent, they are listed among the causes of portal hypertension. PURPOSE The aim of this study was to present the results of intrahepatic APF treatment with embolotherapy in six cases. MATERIAL AND METHODS Transarterial detachable balloon and coil embolization was used on six consecutive cases with traumatic intrahepatic APF from 1989 to 2003. Six-month follow-up angiography was obtained in every case. RESULTS Successful disconnection of hepatic arterial and portal system was achieved in five cases. At least symptomatic improvement was achieved in one. CONCLUSION Transcatheter embolization may be the first line of treatment for intrahepatic APF.
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Affiliation(s)
- Mustafa Tasar
- Department of Radiology, Gülhane Military Medical Academy, Ankara, Turkey.
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16
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Adani GL, Baccarani U, Risaliti A, Sainz-Barriga M, Lorenzin D, Bresadola F. Right lobe living related graft loss due to intrahepatic multiple arterio-portal fistulas. Transplant Proc 2005; 36:2733-5. [PMID: 15621135 DOI: 10.1016/j.transproceed.2004.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report a case of a 38-year-old Caucasian female with ileal carcinoid and bilobar hepatic metastases. After resection of the primary tumor, octreotide therapy was prescribed. Carcinoid histology was positive for chromogranin A and sinaptophsine and negative for MIB1. At 1-year, a follow-up computed tomography scan, Octreoscan, and PET scan were negative for extrahepatic involvement. The patient underwent right lobe living related liver transplantation donated by her sister. Acute hepatic artery thrombosis was successfully revascularized 24 hours after transplantation. Extrahepatic biliary ischemia was treated by a bilio-digestive anastomosis. Eight months later, ascites and clinical and serologic signs of liver failure developed; a liver biopsy revealed fibrosis. Spiral computed tomography scan and hepatic angiography showed multiple intrahepatic arterio-portal fistulas resulting in arterialization and inversion of the portal flow in the absence of graft outflow obstruction.
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Affiliation(s)
- G L Adani
- Department of Surgery and Transplantation Unit, University Hospital, 33100 Udine, Italy
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17
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Sonnenschein MJ, Anderson SE, Lourens S, Triller J. A Rare Case of Jejunal Arterio-Venous Fistula: Treatment with Superselective Catheter Embolization with a Tracker-18 Catheter and Microcoils. Cardiovasc Intervent Radiol 2004; 27:671-4. [PMID: 15578144 DOI: 10.1007/s00270-004-0101-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Arterio-venous fistulas may develop spontaneously, following trauma or infection, or be iatrogenic in nature. We present a rare case of a jejunal arterio- venous fistula in a 35-year-old man with a history of pancreatic head resection that had been performed two years previously because of chronic pancreatitis. The patient was admitted with acute upper abdominal pain, vomiting and an abdominal machinery-type bruit. The diagnosis of a jejunal arterio-venous fistula was established by MR imaging. Transfemoral angiography was performed to assess the possibility of catheter embolization. The angiographic study revealed a small aneurysm of the third jejunal artery, abnormal early filling of dilated jejunal veins and marked filling of the slightly dilated portal vein (13-14 mm). We considered the presence of segmental portal hypertension. The patient was treated with coil embolization in the same angiographic session. This case report demonstrates the importance of auscultation of the abdomen in the initial clinical examination. MR imaging and color Doppler ultrasound are excellent noninvasive tools in establishing the diagnosis. The role of interventional radiological techniques in the treatment of early portal hypertension secondary to jejunal arterio-venous fistula is discussed at a time when this condition is still asymptomatic. A review of the current literature is included.
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Affiliation(s)
- Martin J Sonnenschein
- Department of Diagnostic Radiology, Inselspital Bern, University of Berne, Freiburgstrasse 10, 3010, Berne, Switzerland.
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Huang MS, Lin Q, Jiang ZB, Zhu KS, Guan SH, Li ZR, Shan H. Comparison of long-term effects between intra-arterially delivered ethanol and Gelfoam for the treatment of severe arterioportal shunt in patients with hepatocellular carcinoma. World J Gastroenterol 2004; 10:825-9. [PMID: 15040025 PMCID: PMC4727004 DOI: 10.3748/wjg.v10.i6.825] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To evaluate long-term effect of ethanol embolization for the treatment of hepatocellular carcinoma (HCC) with severe hepatic arterioportal shunt (APS), compared with Gelfoam embolization.
METHODS: Sixty-four patients (ethanol group) and 33 patients (Gelfoam group) with HCC and APS were respectively treated with ethanol and Gelfoam for APS before the routine interventional treatment for the tumor. Frequency of recanalization of shunt, complete occlusion of the shunt, side effects, complications, and survival rates were analyzed between the two groups.
RESULTS: The occlusion rate of APS after initial treatment in ethanol group was 70.3%(45/64), and recanalization rate of 1 month after embolization was 17.8%(8/45), and complete occlusion rate was 82.8%(53/64). Those in Gelfoam group were 63.6%(21/33), 85.7%(18/21), and 18.2%(6/33). There were significant differences in recanalization rate and complete occlusion rate between the two groups (P < 0.05). The survival rates in ethanol group were 78% at 6 months, 49% at 12 months, 25% at 24 months, whereas those in Gelfoam group were 58% at 6 months, 23% at 12 months, 15% at 24 months. The ethanol group showed significantly better survival than Gelfoam group (P < 0.05). In the ethanol group, there was a significant prolongation of survival in patients with monofocal HCC (P < 0.05) and Child class A (P < 0.05). There were no significant differences in survival rate in the Gelfoam group with regard to the number of tumor and Child class (P > 0.05). The incidence rate of abdominal pain during procedure in ethanol group was 82.8%. There was no significant difference in postembolization syndromes between two groups. Procedure-related hepatic failure did not occur in ethanol group.
CONCLUSION: Ethanol embolization for patients with HCC and severe APS is efficacious and safe, and may contribute to prolongation of the life span versus Gelfoam embolization.
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Affiliation(s)
- Ming-Sheng Huang
- Department of Radiology, The 3rd Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road Guangzhou, 510630 China
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