Arterioportal fistulas: twelve cases

Abstract

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.