Arterioportal fistula following liver biopsy. Three cases occurring in liver transplant recipients

Abstract

Although liver biopsy is a very useful procedure used frequently in the diagnosis and management of liver dysfunction occurring after orthotopic liver transplantation, complications can occur with its use. An unusual complication of arterioportal fistula is reported here. Based upon this small series of an unusual event and the knowledge that the posttransplant liver may be more hypervascular than prior to OLTx and that it is uniquely susceptible to hepatic infarction and abscess formation, any attempt at fistula closure should be considered carefully prior to initiating the therapy (15). Unless a serious complication occurs [such as a transient biliary obstruction due to hemobilia as occurred in case 2, portal hypertension as also occurred in case 2, or systemic sepsis or other symptoms develop related directly to the fistula], simple observation may be the best choice of action. Should therapy be required, hepatic arterial embolization should be reserved for adults with intrahepatic fistulas. Primary surgical closure of intrahepatic fistula should be reserved for cases of extrahepatic fistula.

Fig 1

An arterioportal fistula (arrow) in the peripheral right hepatic lobe is demonstrated. Note filling of small portal venous branches distal to the fistula.

Fig 2

Very large arterioportal fistula in the left hepatic lobe of a split liver graft is demonstrated on a selective hepatic arteriogram. Note the markedly enlarged hepatic artery.