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Case Reports
. 2022 Apr 19;32(1):136-141.
doi: 10.1055/s-0042-1743112. eCollection 2022 Mar.

Hepatic Arterioportal Fistula in Patients with Cirrhosis with Endovascular Management-A Series of 4 Cases with Review of Literature

Karamvir Chandel  1 , Ranjan Kumar Patel  1 , Tara Prasad Tripathy  1 , Amar Mukund  1 , Rakhi Maiwall  2 , Shiv Kumar Sarin  2
Affiliations
Case Reports

Hepatic Arterioportal Fistula in Patients with Cirrhosis with Endovascular Management-A Series of 4 Cases with Review of Literature

Karamvir Chandel et al. Indian J Radiol Imaging. .

Abstract

Hepatic arterioportal fistula (APF) in the setting of cirrhosis may aggravate the preexisting portal hypertension and its complications. Cirrhotic patients undergo various percutaneous invasive procedures and are at risk of developing an APF. These should be diagnosed early and should be treated accordingly at the earliest when indicated. Presently embolization is the treatment of choice with coil embolization as the most commonly used method. We describe four cases from our institute with a history of liver parenchymal disease and were found to have acquired APF on imaging. These were successfully managed with transarterial embolization with resolution or improvement in their clinical symptoms on follow-up. The present case series and review emphasize the importance of APF in the setting of liver parenchymal disease and the role of early diagnosis and therapeutic intravascular interventions.

Keywords: arterioportal fistula; cirrhosis; embolization; n-BCA glue; portal hypertension.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Arterioportal fistula (APF) in a 56-year-old patient who presented with hemobilia. Computed tomography arterial phase images, ( A , axial); ( B , coronal), demonstrate an APF between the posterior segmental branch of the right hepatic artery (white arrow) and right branch of the portal vein (black arrow). Selective celiac artery angiogram ( C ) shows early peripheral opacification of portal vein branch (black arrow). A selective arterial angiogram ( D ) reveals an APF between the right hepatic artery branch (white arrow) and dilated branch of the right portal vein (black). Selective coil embolization of the arterial branch ( E ). Check angiogram ( F ) shows no opacification of the hepatic artery branch and APF.
Fig. 2
Fig. 2
Arterioportal fistula (APF) in a 50-year-old with APF and coil migration during angioembolization. Computed tomography arterial phase images, ( A , axial); ( B , coronal), demonstrate hypertrophied right hepatic artery (HA; white arrow) and early aneurysmally dilated right branch of the portal vein (PV) (black arrow) suggestive of an APF. Selective right HA angiogram ( C ) shows two arterial feeders (solid and dashed white arrow) and early opacified dilated PV branch. During coil placement ( D ) initial three coils migrated into the portal vein (asterisk). Post coil embolization ( E ) spot shows embolized larger and smaller feeder with migrated coil mass in PV (asterisk). Check angiogram (F) reveals nonopacification of the APF.
Fig. 3
Fig. 3
Arterioportal fistula (APF) in a 50-year-old patient with a history of plug-assisted transhepatic antegrade obliteration of gastrosplenic shunt. Computed tomography arterial phase images, ( A , axial); ( B , coronal), demonstrate an APF between posterior segmental branch of the right hepatic artery (HA) (white arrow) and portal vein (PV) branch (black arrow). Selective right HA angiogram ( C ) shows hypertrophied right HA and early opacification of a dilated PV branch. Selective segmental HA branch angiogram ( D ) reveals the abnormal fistula with dilated PV (black arrow). Selective coil embolization of the arterial branch ( E ) was done. Check angiogram ( F ) reveals nonopacification of the HA branch and APF. Coil from previous percutaneous hepatic access noted (dashed arrow in A , C ). Metallic artifact (asterisk in A ) from vascular plug noted in the gastrosplenic region from previous shunt closure.
See this image and copyright information in PMC

References

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