Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2019 Jul-Aug;9(4):541-545.
doi: 10.1016/j.jceh.2018.10.001. Epub 2018 Oct 26.

Angioembolization of Post-traumatic Intrahepatic Arterioportal Fistula Presenting With Portal Hypertension

Amar Mukund  1 , Rakhi Maiwall  2 , Naveen Kumar Condati  1
Affiliations
Case Reports

Angioembolization of Post-traumatic Intrahepatic Arterioportal Fistula Presenting With Portal Hypertension

Amar Mukund et al. J Clin Exp Hepatol. 2019 Jul-Aug.

Abstract

Traumatic hepatic arterioportal fistula is an abnormal communication between the hepatic artery and portal vein and is a rare cause of non-cirrhotic portal hypertension with delayed presentation, usually after a remote history of abdominal trauma or an interventional procedure. This case report is of one such rare presentation, wherein a 59-year-old gentleman presented with unexplained ascites and complications of portal hypertension, eventually diagnosed with an arterioportal fistula on a computed tomography scan and managed by angioembolization. There was a remarkable improvement in the complications of portal hypertension after the coil embolization.

Keywords: CT, computed tomography; CTP, Child-Turcotte-Pugh; HVPG, hepatic venous pressure gradient; MELD, model for end-stage liver disease; MR, magnetic resonance; arterioportal fistula; embolization; n-BCA, n-butyl-2-cyanoacrylate; portal hypertension.

PubMed Disclaimer

Figures

Figure 1
Figure 1
CT arterial phase images, (A, axial); (B, coronal); and (C, sagittal), demonstrate the right hepatic artery (red arrow) leading to the arterioportal fistula (black arrow) with an early and rapid opacification of the aneurysmally dilated right branch of the portal vein (blue arrow). CT, computed tomography.
Figure 2
Figure 2
CT arterial phase MIP, maximum intensity projection images, (A and C, coronal) and (B and D, axial), demonstrate the right hepatic artery (red arrow), the arterioportal fistula (black arrow), and the dilated right branch of portal vein (blue arrow). CT, computed tomography.
Figure 3
Figure 3
Selective right hepatic angiogram (A) reveals the abnormal high-flow fistula (black arrow) between the right hepatic artery (red arrow) and the aneurysmally dilated right branch of the portal vein (blue arrow) which shows the early and rapid opacification in the arterial phase (B, C, and D).
Figure 4
Figure 4
Superselective catheterization of the right hepatic artery branch (A) feeding the arterioportal fistula (black arrow). (B) Coil embolization of the fistula and feeding artery with multiple microcoils (green arrow). One migrated coil in the right branch of the portal vein (yellow arrow). Postembolization hepatic angiogram reveals the complete occlusion of the arterioportal fistula with no opacification of the intrahepatic portal vein branches in the early and delayed arterial phases (C and D). Right hepatic artery (red arrow).
Figure 5
Figure 5
CT arterial phase (A and C) and portal venous phase (B and D) images demonstrate densely packed coils (green arrow) causing metallic streak artifacts in the region of the previously noted arterioportal fistula with no early opacification or dilatation of the portal vein branches. No portal vein thrombosis identified. CT, computed tomography.
See this image and copyright information in PMC

References

    1. Guzman E.A., McCahill L.E., Rogers F.B. Arterioportal fistulas: introduction of a novel classification with therapeutic implications. J Gastrointest Surg. 2006;10:543–550. - PubMed
    1. Vauthey J.N., Tomczak R.J., Helmberger T. The arterioportal fistula syndrome: clinicopathologic features, diagnosis, and therapy. Gastroenterology. 1997;113:1390–1401. - PubMed
    1. Choi B.I., Lee K.H., Han J.K., Lee J.M. Hepatic arterioportal shunts: dynamic CT and MR features. Korean J Radiol. 2002;3(1):1–15. - PMC - PubMed
    1. Dessouky B.A., El Abd O.L., Abdel Aal E.S. Intrahepatic vascular shunts: strategy for early diagnosis, evaluation and management. Egyp J Radiol Nucl Med. 2011;42(1):19–34.
    1. Tran T., Burrell M., Lee W.M. Hepatic arterioportal fistulae: two case reports and review of the literature. Clin Med Rev Case Rep. 2015;2:048.

Publication types