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Taher H, Kidr E, Kamal A, ElGobashy M, Mashhour S, Nassef A, Tawfik S, El Tagy G, Shaban M, Eltantawi H, Abdullateef KS. Transhepatic ultrasound guided embolization as a successful novel technique in treatment of pediatric complex intrahepatic arterioportal fistula: a case report and review of the literature. J Med Case Rep 2023; 17:412. [PMID: 37710289 PMCID: PMC10503188 DOI: 10.1186/s13256-023-04047-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/19/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Intrahepatic vascular shunts "IHVS" are abnormal communications between intra-hepatic vasculature involving the arterial, portal, or hepatic venous system. Arterio-portal fistula "APF" is an intrahepatic communication between the hepatic arterial system and the portal venous system without any communication with the systemic venous circulation. APF is considered a rare cause of portal hypertension and gastrointestinal bleeding in infancy. CASE PRESENTATION A 3-month-old Mediterranean female with known cardiac congenital anomalies presented to us with abdominal distension and diarrhea. Ultrasonography revealed massive ascites and computerized tomography (CT) abdomen with intravenous (IV) contrast revealed a left hepatic lesion. On further evaluation, an intrahepatic arterio-portal vascular malformation was detected. Attempted trans arterial embolization failed and radiology team successfully carried out direct trans hepatic ultrasound guided coiling of the aneurysmal venous sac followed by successful resection of segment 4 of the liver with the vascular malformation avoiding life threatening intra operative bleeding. CONCLUSION Any child with recurrent gastrointestinal bleeding, failure to thrive, vomiting, diarrhea, steatorrhea, splenomegaly, or ascites should be investigated for intrahepatic arterio-portal fistula "IAPF". Our novel technique of direct trans hepatic ultrasound guided coiling is an alternative method if trans arterial embolization "TAE" failed.
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Affiliation(s)
- Heba Taher
- Pediatric Surgery Department, Specialized Pediatric Hospital, Cairo University Kasr Al Einy, Faculty of Medicine, 1 Abou El Rish Sq., El Sayeda Zeinab, Cairo, Egypt.
| | - ElSayed Kidr
- Pediatric Surgery Department, Specialized Pediatric Hospital, Cairo University Kasr Al Einy, Faculty of Medicine, 1 Abou El Rish Sq., El Sayeda Zeinab, Cairo, Egypt
| | - Ahmed Kamal
- Pediatric Surgery Department, Specialized Pediatric Hospital, Cairo University Kasr Al Einy, Faculty of Medicine, 1 Abou El Rish Sq., El Sayeda Zeinab, Cairo, Egypt
| | - Mohamed ElGobashy
- Department of Radiology, Cairo University Kasr Al Einy, Faculty of Medicine, Cairo, Egypt
| | - Shady Mashhour
- Department of Radiology, Cairo University Kasr Al Einy, Faculty of Medicine, Cairo, Egypt
| | - Amr Nassef
- Department of Radiology, Cairo University Kasr Al Einy, Faculty of Medicine, Cairo, Egypt
| | | | - Gamal El Tagy
- Department of Radiology, Cairo University Kasr Al Einy, Faculty of Medicine, Cairo, Egypt
| | - Muayad Shaban
- Pediatric Surgery Department, Specialized Pediatric Hospital, Cairo University Kasr Al Einy, Faculty of Medicine, 1 Abou El Rish Sq., El Sayeda Zeinab, Cairo, Egypt
| | - Haytham Eltantawi
- Pediatric Surgery Department, Specialized Pediatric Hospital, Cairo University Kasr Al Einy, Faculty of Medicine, 1 Abou El Rish Sq., El Sayeda Zeinab, Cairo, Egypt
| | - Khaled S Abdullateef
- Pediatric Surgery Department, Specialized Pediatric Hospital, Cairo University Kasr Al Einy, Faculty of Medicine, 1 Abou El Rish Sq., El Sayeda Zeinab, Cairo, Egypt
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Stepanyan SA, Poghosyan T, Manukyan K, Hakobyan G, Hovhannisyan H, Safaryan H, Baghdasaryan E, Gemilyan M. Coil embolization of arterioportal fistula complicated by gastrointestinal bleeding after Caesarian section: A case report. World J Clin Cases 2021; 9:403-409. [PMID: 33521108 PMCID: PMC7812888 DOI: 10.12998/wjcc.v9.i2.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/26/2020] [Accepted: 12/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Most intrahepatic arterioportal fistulae (IAPF) are acquired. The few cases of congenital fistulae are diagnosed in infants and children. CASE SUMMARY We report a 31-year-old female patient presenting with haematemesis and melena three weeks after delivering her second child. The patient had a 20-year history of abdominal distention and nausea. IAPF, along with splenomegaly and ascites, was found by Doppler sonography and confirmed by computed tomography angiography. The patient was treated with endovascular coil embolization, resulting in occlusion of the fistula. CONCLUSION This was an unusual case of possible congenital IAPF that manifested during a second pregnancy and was complicated by portal hypertension.
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Affiliation(s)
- Suren Agho Stepanyan
- Department of Surgery No. 1, Yerevan State Medical University, Yerevan 0025, Armenia
| | - Tigran Poghosyan
- Department of Vascular Surgery, National Center of Oncology, Yerevan 0052, Armenia
| | - Karen Manukyan
- Department of Endoscopy, Mikaelyan University Hospital, Yerevan 0052, Armenia
| | - Gagik Hakobyan
- Department of Gastroenterology and Hepatology, Yerevan State Medical University, Yerevan 0025, Armenia
| | | | - Hayk Safaryan
- Department of Surgery No. 1, Yerevan State Medical University, Yerevan 0025, Armenia
- Department of Surgery, Mikaelyan Institute of Surgery, Yerevan 0052, Armenia
| | | | - Manik Gemilyan
- Department of Gastroenterology and Hepatology, Yerevan State Medical University, Yerevan 0025, Armenia
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Angelico R, Paolantonio G, Paoletti M, Grimaldi C, Saffioti MC, Monti L, Candusso M, Rollo M, Spada M. Combined endovascular-surgical treatment for complex congenital intrahepatic arterioportal fistula: A case report and review of the literature. World J Hepatol 2020; 12:160-169. [PMID: 32685108 PMCID: PMC7336291 DOI: 10.4254/wjh.v12.i4.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/17/2020] [Accepted: 02/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Congenital intrahepatic arterioportal fistula (IAPF) is a rare vascular malformation in infants that causes severe portal hypertension (PH) with poor prognosis if untreated. Currently, radiological embolisation is considered the first-line therapy for simple IAPF; however, it might be not resolutive for complex hepatic vascular lesions. When endovascular embolization is not sufficient to completely obliterate the IAPF, surgical intervention is needed, but it has been associated with severe morbidity and mortality in small children. Furthermore, indications are not defined. CASE SUMMARY We present the first case of a 6-month-old girl with trisomy 21 affected by a complex congenital IAFP, which caused severe PH, successfully treated with an endovascular-surgical hybrid procedure. The novel technique comprised a multi-step endovascular embolisation, including a superselective transarterial embolisation of the afferent vessels and a direct transhepatic embolisation of the dilated portal vein segment, combined with selective surgical ligation of the arterial branches that supply the fistula, which were too small to be embolised. The complex IAPF was also associated with severe cholestasis and intra/extrahepatic biliary tree dilatation, which was successfully treated by a temporary biliary drainage. At 24-mo follow-up, the hybrid endovascular-surgical procedure achieved complete occlusion of the complex IAPF and resolution of the PH. A comprehensive review of the literature on congenital IAPF management, focussed on alternative treatment strategies, is also reported. CONCLUSION The combined radiological-surgical approach is a safe and effective treatment option for complex IAPF and avoids major invasive surgery.
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Affiliation(s)
- Roberta Angelico
- Department of Abdominal Transplantation and Hepatobiliary and Pancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy
| | - Guglielmo Paolantonio
- Interventional Radiology Unit, Department of Imaging, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy
| | - Monica Paoletti
- Department of Abdominal Transplantation and Hepatobiliary and Pancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy
| | - Chiara Grimaldi
- Department of Abdominal Transplantation and Hepatobiliary and Pancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy
| | - Maria Cristina Saffioti
- Department of Abdominal Transplantation and Hepatobiliary and Pancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy
| | - Lidia Monti
- Department of Imaging, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy
| | - Manila Candusso
- Division of Hepatogastroenterology, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy
| | - Massimo Rollo
- Interventional Radiology Unit, Department of Imaging, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy
| | - Marco Spada
- Department of Abdominal Transplantation and Hepatobiliary and Pancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy.
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Chaudry G, Lillis AP, Shaikh R, Padua HM, Chewning RH, Alomari AI. Endovascular Treatment of Congenital Arterioportal Fistulas. Cardiovasc Intervent Radiol 2018; 41:1021-1028. [PMID: 29511867 DOI: 10.1007/s00270-018-1924-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 02/24/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE To characterize anatomy of congenital arterioportal fistulas (CAPF) and correlate this with technique and outcomes of transcatheter embolization (TCE). MATERIALS AND METHODS Retrospective review was conducted of children with CAPF that underwent TCE in a 10-year period. Medical records, imaging and procedure details were reviewed. TCE was performed via transarterial (n = 5), portal (n = 5) or patent ductus venosus (n = 1) approach. Embolic agents used were coils (n = 10), Onyx (n = 1) and Amplatzer septal occluder (n = 1). RESULTS A total of 7 patients were included (4 female). Median age at treatment was 4 months (2 month-3 year). Most common symptoms were GI bleeding (n = 4), anemia (n = 4) and ascites (n = 3). Hepatopetal flow was seen in all on pre-procedure sonography. On angiography, a simple lesion, with direct fistulous connections, from hepatic arterial (HA) branches to portal venous (PV) system was seen in 3. A complex lesion with multiple connections was identified in 4. In simple lesions, cessation of shunting was achieved in 1 procedure, with embolization of afferent vessels. In complex lesions, multiple procedures were required in 3 of 4 patients. All 4 with complex connections required embolization of the aneurysmal PV segment. There were no major complications. Two minor complications were noted: localized biliary leak in 1 and femoral pseudoaneurysm in 1. There was resolution of symptoms in 6. CONCLUSIONS TCE is effective as primary treatment of CAPF. Patients with simple arteriovenous connections can be treated with embolization of afferent vessels, but children with multiple complex connections usually require embolization of the dilated PV segment.
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Affiliation(s)
- Gulraiz Chaudry
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Anna P Lillis
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Raja Shaikh
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Horacio M Padua
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Rush H Chewning
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Ahmad I Alomari
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
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Wu L, Zhao L, Lu Y, He L, Hu X. Interventional embolization of congenital intrahepatic shunts in children. Pediatr Radiol 2016; 46:541-7. [PMID: 26637318 DOI: 10.1007/s00247-015-3497-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 08/28/2015] [Accepted: 10/28/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Congenital intrahepatic shunts in children are rare and precise treatment strategies have not been established. OBJECTIVE The purpose of this study was to present our experience with transcatheter embolization in a descriptive case series of congenital intrahepatic shunts in children. MATERIALS AND METHODS We retrospectively studied 10 children with symptomatic congenital intrahepatic shunts who were treated with embolization at our institute between January 2008 and December 2014. RESULTS Seven children had arteriovenous shunts in association with hepatic hemangiomas, two had arterioportal shunts and one had portosystemic shunts. The major presentations were congestive heart failure and severe anemia in the groups with arteriovenous and arterioportal shunts, respectively. Following embolization, two children died in the arteriovenous group, one from progressive liver dysfunction and the other from abdominal compartment syndrome. One child in the arterioportal group required liver transplantation after initial embolization. With mean post-procedure follow-up of 15 months (range 4-54 months), all the remaining children were well, with resolution of the symptoms. CONCLUSION Interventional embolization provides an alternative to surgical ligation or hepatic resection in children with clinically significant intrahepatic shunts. For lesions with complex morphology, embolization may be inadequate and liver transplantation might be the only therapeutic option.
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Affiliation(s)
- Lin Wu
- Cathererization Laboratory, Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China
| | - Lu Zhao
- Cathererization Laboratory, Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China
| | - Ying Lu
- Cathererization Laboratory, Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China
| | - Lan He
- Cathererization Laboratory, Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China
| | - Xihong Hu
- Department of Radiology, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China.
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Congenital arterioportal fistulas: radiological treatment and color Doppler US follow-up. Pediatr Radiol 2012; 42:1326-32. [PMID: 22699373 DOI: 10.1007/s00247-012-2443-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 05/15/2012] [Accepted: 05/16/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Congenital intrahepatic arterioportal fistulas (APFs) are a rare cause of portal hypertension in children. Doppler US is a useful diagnostic imaging modality. Transarterial embolization is a minimally invasive and effective therapy allowing occlusion of the fistula and restoration of liver hemodynamics. OBJECTIVE To describe the clinical and radiologic findings, percutaneous treatment and role of D-US in the postembolization follow-up of children with APF. MATERIALS AND METHODS Between 2002 and 2011, four children with APF were treated. Initial diagnosis and follow-up was performed with D-US and confirmed by arteriography, followed by endovascular embolization in all patients. RESULTS D-US demonstrated abnormal arterioportal communications in all patients. Six endovascular procedures were performed in these four children. In two children, no residual fistula was seen on D-US after the first procedure and symptoms resolved. In the other two children, D-US demonstrated residual flow through the fistula, with resolution of pathological D-US findings and symptoms after the second endovascular procedure. All four children were successfully treated and asymptomatic at the end of follow-up. The mean follow-up was 24 months. CONCLUSION Interventional radiology has a key role in the treatment of congenital APF. D-US is a noninvasive and effective tool for the diagnosis and follow-up of these patients.
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Portal vascular anomalies in Down syndrome: spectrum of clinical presentation and management approach. J Pediatr Surg 2010; 45:1676-81. [PMID: 20713219 DOI: 10.1016/j.jpedsurg.2010.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 03/09/2010] [Accepted: 03/10/2010] [Indexed: 11/21/2022]
Abstract
PURPOSE The occurrence of portal vascular anomalies in Down syndrome has been sporadically reported in the literature. These rare disorders have a wide spectrum of anatomical and clinical presentations. The aim of this communication was to describe the clinical course, imaging features, and management approaches in patients with this association. METHODS We conducted a comprehensive search of the databases of the Vascular Anomalies Center and the Department of Radiology at Children's Hospital Boston for patients with Down syndrome and portal vascular anomalies. Medical records and imaging studies of varying modalities were reviewed. RESULTS Three children with Down syndrome and portal anomalies (portosystemic shunt, simple arterioportal shunt, complex arterioportal shunt) were managed at our institution. The portosystemic shunt was clinically insignificant and resolved without any intervention. The simple arterioportal shunt was successfully treated with embolization. The complex arterioportal shunt was associated with major congenital cardiac defects and the child ultimately expired despite a decrease in the arterioportal shunting after embolization. CONCLUSIONS Three is a wide spectrum of clinical and anatomical features of portal vascular shunts in Down syndrome. The management approach should be tailored based on the severity of symptoms. Percutaneous embolization can offer a safe, effective, and minimally invasive alternative to the surgical approach in selective cases.
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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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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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Coil embolization of a congenital intrahepatic arterioportal fistula: increasing experience in management. Pediatr Radiol 2008; 38:1253-6. [PMID: 18690425 DOI: 10.1007/s00247-008-0957-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2008] [Revised: 05/06/2008] [Accepted: 06/10/2008] [Indexed: 10/21/2022]
Abstract
Congenital intrahepatic arterioportal fistula (IAPF) is a rare condition and there is limited experience of transcatheter embolization. We report here the transcatheter coil embolization of an incidentally found, asymptomatic congenital IAPF in a 16-month-old patient. After demonstrating that the IAPF was fed by two branches of a dilated left hepatic artery and drained into an aneurysm of the left portal vein, the feeding arteries were superselectively catheterized and occluded by microcoils in a single session. Follow-up was uneventful for 1 year. With respect to this and previously reported cases, we believe that embolization of feeding arteries is a safe and effective method that should be the primary choice of treatment; however, further cases should be reported to confirm this belief.
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Sutcliffe R, Mieli-Vergani G, Dhawan A, Corbally M, Karani J, Heaton N. A novel treatment of congenital hepatoportal arteriovenous fistula. J Pediatr Surg 2008; 43:571-3. [PMID: 18358306 DOI: 10.1016/j.jpedsurg.2005.07.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Congenital hepatoportal arteriovenous fistula is a rare cause of portal hypertension in young children. Unlike the acquired form, which is usually isolated and can be cured by hepatic artery (HA) embolization, recurrence of portal hypertension often occurs with congenital hepatoportal arteriovenous fistula after embolization and/or HA ligation because of early, rapid collateralization and the presence of multiple arterioportal fistula. Although long-term outcome after embolization is not known, liver transplantation has been proposed as the only option for this condition. However, portal vein and hepatic arterial anastomoses are made difficult because of the presence of portal vein arterialization and previous HA ligation, with a significantly increased risk of vascular complications. We report a case where resolution of portal hypertension has been achieved by an end-to-side portocaval shunt, to preserve the portal vein and HA for future liver transplantation, should it be required.
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Affiliation(s)
- R Sutcliffe
- Liver Transplant Surgical Service, King's College Hospital, London SE5 9RS, UK
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Falkenstein K, Flynn L, Dunn S, Baldridge A. Arterial-venous fistulas following pediatric liver transplant case studies. Pediatr Transplant 2007; 11:683-8. [PMID: 17663695 DOI: 10.1111/j.1399-3046.2007.00742.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AV fistula is a rare but serious complication following pediatric liver transplant and may lead to graft loss. Our aim was to describe two pediatric centers' experience with the diagnosis, treatment and outcomes of children who presented with AV fistulas post-liver transplantation We report five cases of late arterio-portal fistula following liver transplantation. Four children were successfully treated with coil embolization. All of the children in this series had liver biopsies within 2-6 months of their AV fistula diagnosis. All biopsies were performed using a Bard Monopty 18 gauge needle with no ultrasound guidance and only one pass per biopsy. Two children also had PTC 4-8 months prior to their diagnosis of AV fistula. Three of the five children in this series had GI bleeds requiring banding or sclerotherapy. The other two had varices found on CT scan. All five cases in this series had ascites on their initial presentation. Four out of the five children had a history of non-compliance and the other child had a history of malabsorption and chronic diarrhea.
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Affiliation(s)
- Kathleen Falkenstein
- PNP Drexel University, Philadelphia, PA, and Dupont Hospital for Children, USA. kf33@drexeledu
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13
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Garg MK, Lal A, Bapuraj RJ. Congenital hepatoportal arteriovenous fistula leading to segmental portal hypertension and splenic vein thrombosis. J Pediatr Gastroenterol Nutr 2007; 45:265-7. [PMID: 17667727 DOI: 10.1097/mpg.0b013e31803cd52e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Mandeep Kumar Garg
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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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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Norton SP, Jacobson K, Moroz SP, Culham G, Ng V, Turner J, John P. The congenital intrahepatic arterioportal fistula syndrome: elucidation and proposed classification. J Pediatr Gastroenterol Nutr 2006; 43:248-55. [PMID: 16877994 DOI: 10.1097/01.mpg.0000221890.13630.ad] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Congenital intrahepatic arterioportal fistula is a rare but treatable cause of portal hypertension for which early recognition may lead to successful radiological management. We report an infant presenting with severe failure to thrive, melena and splenomegaly due to a congenital intrahepatic arterioportal fistula, successfully ablated after multiple trials of superselective transarterial embolization. Comprehensive review of congenital cases provides an understanding of the key clinical features defining this syndrome. A classification system is proposed, upon which treatment decisions may be based.
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Affiliation(s)
- Seamus P Norton
- Department of Pediatrics, British Columbia's Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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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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Chae EJ, Goo HW, Kim SC, Yoon CH. Congenital intrahepatic arterioportal and portosystemic venous fistulae with jejunal arteriovenous malformation depicted on multislice spiral CT. Pediatr Radiol 2004; 34:428-31. [PMID: 14685789 DOI: 10.1007/s00247-003-1093-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2003] [Revised: 10/06/2003] [Accepted: 10/06/2003] [Indexed: 01/30/2023]
Abstract
We report a symptomatic infant with very rare congenital arterioportal and portosystemic venous fistulae in the liver. Multislice CT after partial transcatheter embolisation revealed not only the complicated vascular architecture of the lesion, but also an incidental jejunal arteriovenous malformation which explained the patient's melena. The patient underwent ligation of the hepatic artery and resection of the jejunal arteriovenous malformation. Postoperative multislice CT clearly demonstrated the success of the treatment.
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Affiliation(s)
- Eun Jin Chae
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap2-dong, Songpa-gu 138-736, Seoul, Korea
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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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