Endovascular Treatment of Congenital Arterioportal Fistulas

Lillis, Anna P.; Shaikh, Raja; Padua, Horacio; Chewning, Rush H.; Alomari, Ahmad I.

doi:10.1007/s00270-018-1924-1

Cited by 15 publications

(14 citation statements)

References 19 publications

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“…An important application for these agents used alone or in combination with other devices, showing that satisfactory results are found in vascular lesions’ embolization, such as a giant hepatic hemangioma treated with trans-arterial administration of EVOH and PV [ 13 ], a congenital arterioportal fistula treated with a two-step procedure, first with NALEA and then with coils and Amplatzer septal occluder [ 58 ] and giant hepatic artery aneurysms treated with EVOH and coils [ 59 ], or, in a patient with immunoglobulin G4-related disease, with NALEA, coiling using 20 cm guidewire fragments, and arterial inflow closure with a vascular plug [ 60 ].…”

Section: Tumor Embolizationmentioning

confidence: 99%

Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature

Piacentino

Fontana

Curti

et al. 2021

JCM

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This review focuses on the use of “new” generation of non-adhesive liquid embolic agents (NALEA). In literature, non-adhesive liquid embolic agents have mainly been used in the cerebral district; however, multiple papers describing the use of NALEA in the extracranial district have been published recently and the aim of this review is to explore and analyze this field of application. There are a few NALEA liquids such as Onyx, Squid, and Phil currently available in the market, and they are used in the following applications: mainly arteriovenous malformations, endoleaks, visceral aneurysm or pseudoaneurysm, presurgical and hypervascular lesions embolization, and a niche of percutaneous approaches. These types of embolizing fluids can be used alone or in combination with other embolizing agents (such as coils or particles) so as to enhance its embolizing effect or improve its possible defects. The primary purpose of this paper is to evaluate the use of NALEAs, predominantly used alone, in elective embolization procedures. We did not attempt a meta-analysis due to the data heterogeneity, high number of case reports, and the lack of a consistent follow-up time period.

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Section: Tumor Embolizationmentioning

confidence: 99%

Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature

Piacentino

Fontana

Curti

et al. 2021

JCM

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“…These findings suggest that the anticoagulant therapy might be prolonged after the procedure, but further data are needed to define the type and duration of anticoagulant regimen. Other embolisation-related risks include movement of the embolic agents to an incorrect site, pseudoaneurysm of the accessed artery and bile duct injury[ 31 ], none of which were observed in the current case.…”

Section: Discussionmentioning

confidence: 96%

“…In the literature, the experience of congenital IAPF is limited to case report or small case series[ 1 , 3 , 5 , 8 - 31 ]. To the best of our knowledge, of 44 congenital IAPF cases described so far, the majority of lesions were type-1 ( n = 19; 43.2%) according to the Norton et al[ 3 ] classification, followed by type-2 ( n = 10; 22.7%) and type-3 ( n = 10; 22.7%) IAPF.…”

Section: Discussionmentioning

confidence: 99%

Combined endovascular-surgical treatment for complex congenital intrahepatic arterioportal fistula: A case report and review of the literature

Angelico

Paolantonio

Paoletti

et al. 2020

WJH

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BACKGROUND Congenital intrahepatic arterioportal fistula (IAPF) is a rare vascular malformation in infants that causes severe portal hypertension (PH) with poor prognosis if untreated. Currently, radiological embolisation is considered the first-line therapy for simple IAPF; however, it might be not resolutive for complex hepatic vascular lesions. When endovascular embolization is not sufficient to completely obliterate the IAPF, surgical intervention is needed, but it has been associated with severe morbidity and mortality in small children. Furthermore, indications are not defined. CASE SUMMARY We present the first case of a 6-month-old girl with trisomy 21 affected by a complex congenital IAFP, which caused severe PH, successfully treated with an endovascular-surgical hybrid procedure. The novel technique comprised a multi-step endovascular embolisation, including a superselective transarterial embolisation of the afferent vessels and a direct transhepatic embolisation of the dilated portal vein segment, combined with selective surgical ligation of the arterial branches that supply the fistula, which were too small to be embolised. The complex IAPF was also associated with severe cholestasis and intra/extrahepatic biliary tree dilatation, which was successfully treated by a temporary biliary drainage. At 24-mo follow-up, the hybrid endovascular-surgical procedure achieved complete occlusion of the complex IAPF and resolution of the PH. A comprehensive review of the literature on congenital IAPF management, focussed on alternative treatment strategies, is also reported. CONCLUSION The combined radiological-surgical approach is a safe and effective treatment option for complex IAPF and avoids major invasive surgery.

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“…Contrast-enhanced CT and contrast-enhanced magnetic resonance imaging may be used to confirm the US findings [3] . Conventional angiography is the gold-standard imaging modality as it can precisely outline the vascular anatomy and also serve therapeutic purposes [9] . Management of IAPF focuses on occlusion of the fistula and recovery of normal intrahepatic hemodynamics [2] .…”

Section: Discussionmentioning

confidence: 99%

Successful embolization of a congenital intra-hepatic arterioportal fistula in a neonate with the MVP Microvascular Plug system (MVP-3Q)

Gladkikh

Parra

2022

Radiology Case Reports

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This case report describes a neonate with an antenatally diagnosed vascular anomaly of the liver. Ultrasound at birth confirmed an arterioportal fistula communicating the left hepatic artery and an anterior branch of the right portal vein. Computer tomography angiography on day 7 of life redemonstrated the arterioportal fistula and defined the vascular anatomy for potential treatment. Transarterial embolization of the arterioportal fistula was performed at 3 weeks of life using an MVP Microvascular Plug System 3Q (Reverse Medical Corp, Irvine, CA, USA). Intra-procedural angiography showed successful occlusion of the fistula, patency of the portal vein with hepatopetal flow, and patency of the hepatic artery with no signs of arterial or venous thrombosis. There were no intra- or post-procedure complications. Multiple follow-up ultrasounds at 1-13 months showed stable occlusion of the embolized fistula with no evidence of recanalization, with the patient having a normal life and no sequelae. This case illustrates a successful novel approach to manage the rare condition of a solitary hepatic arterioportal fistula in a neonate using the MVP system. Current literature on congenital arterioportal fistulas and the MVP system is reviewed.

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Endovascular Treatment of Congenital Arterioportal Fistulas

Abstract: TCE is effective as primary treatment of CAPF. Patients with simple arteriovenous connections can be treated with embolization of afferent vessels, but children with multiple complex connections usually require embolization of the dilated PV segment.

Cited by 15 publications

References 19 publications

Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature

Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature

Combined endovascular-surgical treatment for complex congenital intrahepatic arterioportal fistula: A case report and review of the literature

Successful embolization of a congenital intra-hepatic arterioportal fistula in a neonate with the MVP Microvascular Plug system (MVP-3Q)

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