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Okuhira R, Sonomura T, Tanaka R, Inagaki R, Ueda S, Fukuda K, Higashino N, Kamisako A, Sato H, Ikoma A, Minamiguchi H. Successful coil embolization of post-hepatectomy arterioportal fistula that reduced ascites and improved liver function. Radiol Case Rep 2024; 19:2206-2210. [PMID: 38515772 PMCID: PMC10955095 DOI: 10.1016/j.radcr.2024.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 03/23/2024] Open
Abstract
A 71-year-old man had previously undergone S7 + S8 dorsal segmentectomy and S5 partial hepatectomy for hepatocellular carcinomas. Six months later, he experienced abdominal distention. Abdominal computed tomography (CT) showed massive ascites and a significant hepatic arterioportal shunt. The ascites was thought to be caused by portal hypertension due to a high-flow hepatic arterioportal fistula (HAPF). The fistula, located between the right hepatic artery A7 and the right portal vein, was embolized with microcoils under flow control using a balloon catheter. After embolization, the shunt blood flow disappeared and the hepatopetal venous flow was restored. His body weight and abdominal circumference decreased immediately, and his liver function on blood tests improved after the procedure. CT performed 11 days after embolization showed decreased ascites. A HAPF after hepatectomy is extremely rare. Balloon-assisted embolization using microcoils is a useful endovascular procedure for treating a high-flow HAPF.
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Affiliation(s)
- Ryuta Okuhira
- The Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Tetsuo Sonomura
- The Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Ryota Tanaka
- The Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Riki Inagaki
- The Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Shota Ueda
- The Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Kodai Fukuda
- The Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Nobuyuki Higashino
- The Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Atsufumi Kamisako
- The Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Hirotatsu Sato
- The Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Akira Ikoma
- The Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Hiroki Minamiguchi
- The Department of Radiology, Wakayama Medical University, Wakayama, Japan
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Marra P, Dulcetta L, Carbone FS, Agazzi R, Muglia R, Bonaffini PA, Bonanomi E, Colledan M, D'Antiga L, Venturini M, Sironi S. Arterioportal Fistulas (APFs) in Pediatric Patients: Single Center Experience with Interventional Radiological versus Conservative Management and Clinical Outcomes. J Clin Med 2021; 10:2612. [PMID: 34198478 DOI: 10.3390/jcm10122612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 02/07/2023] Open
Abstract
Arterioportal fistulas (APFs) are uncommon vascular abnormalities with a heterogeneous etiology. In pediatric orthotopic liver transplantation (OLT), APFs are frequently iatrogenic, following percutaneous liver interventions. The aim of this study was to report the 10-year experience of a tertiary referral center for pediatric OLT in the interventional radiological (IR) and conservative management of acquired APFs. A retrospective search was performed to retrieve pediatric patients (<18 years old) with a diagnosis of APF at color Doppler ultrasound (CDUS) or computed tomography angiography (CTA) from 2010 to 2020. Criteria for IR treatment were the presence of hemodynamic alterations at CDUS (resistive index <0.5; portal flow reversal) or clinical manifestations (bleeding; portal hypertension). Conservatively managed patients served as a control population. Clinical and imaging follow-up was analyzed. Twenty-three pediatric patients (median age, 4 years; interquartile range = 11 years; 15 males) with 24 APFs were retrieved. Twenty patients were OLT recipients with acquired APFs (16 iatrogenic). Twelve out of twenty-three patients were managed conservatively. The remaining 11 underwent angiography with confirmation of a shunt in 10, who underwent a total of 16 embolization procedures (14 endovascular; 2 transhepatic). Technical success was reached in 12/16 (75%) procedures. Clinical success was achieved in 8/11 (73%) patients; three clinical failures resulted in one death and two OLTs. After a median follow-up time of 42 months (range 1–107), successfully treated patients showed an improvement in hemodynamic parameters at CDUS. Conservatively managed patients showed a stable persistence of the shunts in six cases, spontaneous resolution in four, reduction in one and mild shunt increase in one. In pediatric patients undergoing liver interventions, APFs should be investigated. Although asymptomatic in most cases, IR treatment of APFs should be considered whenever hemodynamic changes are found at CDUS.
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Kimura Y, Hori T, Machimoto T, Ito T, Hata T, Kadokawa Y, Kato S, Yasukawa D, Aisu Y, Takamatsu Y, Kitano T, Yoshimura T. Portal vein aneurysm associated with arterioportal fistula after hepatic anterior segmentectomy: Thought-provoking complication after hepatectomy. Surg Case Rep 2018; 4:57. [PMID: 29904893 PMCID: PMC6002328 DOI: 10.1186/s40792-018-0465-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/04/2018] [Indexed: 11/17/2022] Open
Abstract
Background Few cases of postoperative arterioportal fistula (APF) have been documented. APF after hepatectomy is a very rare surgery-related complication. Case presentation A 62-year-old man was diagnosed with hepatocellular carcinoma in segments 5 and 8, respectively. Anterior segmentectomy was performed as a curative surgery. Each branch of the hepatic artery, portal vein, and biliary duct for the anterior segment was ligated together as the Glissonean bundle. The patient was discharged on postoperative day 14. Three months later, dynamic magnetic resonance imaging showed an arterioportal fistula and portal vein aneurysm. Surprisingly, the patient did not have subtle symptoms. Although a perfect angiographic evaluation could not be ensured, we performed angiography with subsequent interventional radiology to avoid sudden rupture. Arteriography was immediately performed to create a portogram via the APF from the stump of the anterior hepatic artery, and portography clearly revealed hepatofugal portal vein flow. Portography also showed that the stump of the anterior portal vein had developed a 40-mm-diameter portal vein aneurysm. Selective embolization of the anterior hepatic artery was accomplished in the whole length of the stump of the anterior hepatic artery, and abnormal blood flow through the APF was drastically reduced. The portal vein aneurysm disappeared, and portal flow was normalized. Dynamic computed tomography after embolization clearly demonstrated perfect interruption of the APF. The patient maintained good health thereafter. Conclusions Post-hepatectomy APFs are very rare, and some appear to be cryptogenic. Our thought-provoking case may help to provide a possible explanation of the causes of post-hepatectomy APF.
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Affiliation(s)
- Yusuke Kimura
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan.
| | - Tomohide Hori
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan.
| | - Takafumi Machimoto
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Tatsuo Ito
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Toshiyuki Hata
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Yoshio Kadokawa
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Shigeru Kato
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Daiki Yasukawa
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Yuki Aisu
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Yuichi Takamatsu
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Taku Kitano
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Tsunehiro Yoshimura
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
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Puri Y, Srinivasan P, Peddu P, Heaton N. Case Report of Multiple Bilobar Hepatic Arterio-Portal Fistulas Post-Liver Transplantation Managed Conservatively. Transplant Proc 2018; 50:920-924. [PMID: 29661463 DOI: 10.1016/j.transproceed.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/24/2017] [Accepted: 12/04/2017] [Indexed: 10/17/2022]
Abstract
Multiple intrahepatic arterio-portal fistulas are rare. The majority are isolated and occur secondary to liver trauma including iatrogenic interventions such as liver biopsy. Post-liver transplantation 18 cases have been reported, all secondary to an interventional radiological procedure. We report multiple bi-lobar arterio-portal fistulas in a liver transplant recipient recognized 1 year after transplantation. The donor died due to intracerebral bleeding following blunt head and abdominal trauma. In the present case, the etiology is not very clear. The patient was managed conservatively and to date has not required intervention.
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Affiliation(s)
- Y Puri
- Institute of Liver Studies, King's College Hospital, Denmark Hill, England.
| | - P Srinivasan
- Institute of Liver Studies, King's College Hospital, Denmark Hill, England
| | - P Peddu
- Institute of Liver Studies, King's College Hospital, Denmark Hill, England
| | - N Heaton
- Institute of Liver Studies, King's College Hospital, Denmark Hill, England
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Balci D, Dayangac M, Yaprak O, Akin B, Duran C, Killi R, Yuzer Y, Tokat Y. Living donor liver transplantation for hepatocellular carcinoma: a single center analysis of outcomes and impact of different selection criteria. Transpl Int 2011; 24:1075-83. [DOI: 10.1111/j.1432-2277.2011.01311.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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