Endoluminal Management of Arterioportal Fistulae in Liver Transplant Recipients: A Single-Center Experience

• Published in: Vascular and endovascular surgery 2007-12, Vol.40 (6), p.451-459
• Main Authors: Saad, Wael E. A., Davies, Mark G., Rubens, Deborah J., Sahler, Lawrence G., Patel, Nikhil C., Lee, David E., Kitanosono, Takashi, Sasson, Talia, Waldman, David L.
• Format: Article
• Language: English
• Subjects: Adolescent; Arteriovenous Fistula - diagnostic imaging; Arteriovenous Fistula - etiology; Arteriovenous Fistula - therapy; Biological and medical sciences; Dermatology; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Hepatic Artery - diagnostic imaging; Humans; Infant; Liver Transplantation - adverse effects; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Portal Vein - diagnostic imaging; Retrospective Studies; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography; United States; Vascular disorders of the skin; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 1538-5744; 1938-9116
• DOI: 10.1177/1538574406294072

Transcatheter embolization of arterioportal fistulae in liver transplant recipients is restricted to symptomatic arterioportal fistulae. Angiograms of liver transplant recipients from a single university medical center were retrospectively reviewed. Hemodynamically significant arterioportal fistulae were defined as those exhibiting opacification of the main portal vein of the transplanted hepatic graft or its first order branch with or without portal venous changes by Doppler ultrasound imaging. Six arterioportal fistulae were found. Doppler ultrasound imaging detected 50% of all arterioportal fistulae and all 3 hemodynamically significant arterioportal fistulae. Three successful embolizations were performed. Follow-up (37 to 67 months) demonstrated patent hepatic arteries and no parenchymal ischemic changes with graft preservation. High-throughput arterioportal fistulae may require larger intrahepatic artery branch embolization. There is a window of opportunity for embolizing significant arterioportal fistulae before their progression to large symptomatic, high through-put arterioportal fistulae with their added risk of ischemic changes before and after embolization.