Gastric variceal bleeding caused by an intrahepatic arterioportal fistula that formed after liver biopsy: a case report and review of the literature

Iwaki, Takaaki; Matsuda, Hiroyuki; Yoshida, Yukio; Matsuura, Keiichi; Suminaga, Yoshihisa

doi:10.1007/s12328-011-0277-y

Cited by 15 publications

(13 citation statements)

References 30 publications

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“…The arterioportal fistula formation caused by TIPS was also reported to be rare [8]. Furthermore, iatrogenic etiologies include percutaneous portal vein [9] and liver biopsy [10], which can cause hepatic artery-portal vein fistula creation.…”

Section: Discussionmentioning

confidence: 99%

Gastric Variceal Bleeding Caused by an Arterioportal Fistula Formation After TIPS and Related Complications

et al. 2016

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A 70-year-old man was referred to our institution due to 2 days of vomiting and melena, 20 months after the placement of a transjugular intrahepatic portosystemic shunt (TIPS). He underwent TIPS treatment in another hospital due to repeated upper gastrointestinal variceal bleeding (GI) secondary to alcoholic cirrhosis and portal hypertension.Up until this point, abdominal ultrasound follow-up indicated intrahepatic stent patency, and gastrointestinal bleeding did not occur again. Suddenly and without an obvious trigger, he vomited approximately 1000 ml of blood and produced 500 g of black stool without blood clots, cough, sputum, or discomfort.Despite transfusion of 8 u of packed RBCs and 400 ml plasma, hemostasis, rehydration and anti-infective measures, he continued to frequently vomit large volumes and produce bright red stools. Emergency endoscopy revealed severe esophageal and gastric variceal bleeding. His esophageal varices were ligated, and the fundus varices were treated by tissue glue injection. A CT revealed arterial phase enhancement of the right portal vein which was markedly widened, and that arterial phase had developed with intrahepatic stent patency (Fig. 1). Based on these data, we surmised that an arterioportal fistula had formed. Hepatic arteriography and arterioportal fistula occlusion were performed through the femoral artery. Briefly, after the catheter was inserted into the target liver artery end of fistula, a suitable size rim (3 mm, COOK, USA) was put into the fistula, and appropriate gelatin sponge tablets were injected into the fistula. Then, another hepatic arteriography showed no portal vein development, and the hepatic artery showed significantly enhanced development compared with before fistula occlusion (Fig. 2). After fistula occlusion, hematemesis ceased, and the melena disappeared over 6 months.

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Section: Discussionmentioning

confidence: 99%

Gastric Variceal Bleeding Caused by an Arterioportal Fistula Formation After TIPS and Related Complications

et al. 2016

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“…Since 1977 there have been 30 reported cases of symptomatic intrahepatic APFs following percutaneous liver biopsy. Of those cases, 13 presented with gastrointestinal bleeding secondary to esophageal varices or hemobilia and only 1 case presented as a gastric variceal bleed [9].…”

Section: Discussionmentioning

confidence: 99%

Hepatic Arterioportal Fistula Presenting as Gastric Variceal Hemorrhage

Kakati¹,

Pedersen

Chen

et al. 2014

JGLD

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Hepatic arterioportal fistulae (APF) are abnormal communications between the hepatic artery and the portal vein. In this report, we present the second case in the literature of a symptomatic APF presenting as a gastric variceal bleeding. A 55-year-old female presented to our facility with hematemesis. Upper endoscopy revealed a bleeding gastric varix. A computed tomography scan identified a large left hepatic lobe APF between the left hepatic artery and the left portal vein. Through angiography coil embolization was performed and with resultant loss of arterial flow, the APF was decompressed. On hospital day 3, the patient developed new melena. Portovenogram was performed and a TIPS stent was deployed. The patient subsequently did well. Hepatic arterioportal fistulae can result in portal hypertension secondary to arterial blood flowing directly into the portal vein bypassing the hepatic sinusoids. Iatrogenic causes (e.g. percutaneous liver biopsy) represent more than 50% of published cases of APFs. Most APFs resolve spontaneously as they are small and peripherally located. In rare instances, when APFs are centrally located, clinical symptoms develop. There have been 30 reported cases of symptomatic intrahepatic APFs following percutaneous liver biopsy. Of those, only one case presented as a gastric variceal bleed. Digital subtraction angiography is the gold standard in the diagnosis and treatment of APFs. In addition to initial embolization, we elected to treat the patient with TIPS due to the magnitude of her bleed. Although rare, intrahepatic APF should be kept on the differential of a patient presenting with isolated gastric varices.

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“…Furthermore, the study introduces a new term instead of PVA to describe this vascular reconstruction method; since the blood supplies of the graft liver in both the hepatic artery and portal vein are from same source (arterial blood from the graft celiac artery), the term is liver dual arterial blood supply (LDABS). LDABS differs from arterioportal fistula ( 9 ), partial portal vein arterialization (PPVA) ( 10 ) or arterialized portal vein blood supply alone during which the hepatic artery blood supply ceased owing to thrombosis, surgical ablation or injury ( 11 , 12 ).…”

Section: Discussionmentioning

confidence: 99%

A new rat model of auxiliary partial heterotopic liver transplantation with liver dual arterial blood supply

Qiao

Han

Zhang

et al. 2014

Experimental and Therapeutic Medicine

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Auxiliary partial heterotopic liver transplantation (APHLT) with portal vein arterialization is a valuable procedure to be considered in the treatment of patients with acute liver failure and metabolic liver diseases. The aim of this study was to develop a new rat model of APHLT with liver dual arterial blood supply (LDABS). A total of 20 rats were used. The donor liver was resected, and the celiac trunk was reserved. Left and medial hepatic lobes accounting for 70% of the liver mass were removed en bloc and the suprahepatic caval vein was ligated simultaneously. Thus, 30% of the donor liver was obtained as the graft. Sleeve anastomosis of the graft portal vein and splenic artery were performed after narrowing the portal vein lumen through suturing. The right kidney of the recipient was removed, and sleeve anastomosis was performed between the celiac trunk of the graft and the right renal artery of the recipient. In addition, end-to-end anastomosis was performed between the infrahepatic caval vein of the graft and the right renal vein of the recipient. Following the reperfusion of the graft, the blood flow of the arterialized portal vein was controlled within the physiological range through suturing and narrowing under monitoring with an ultrasonic flowmeter. The bile duct of the graft was implanted into the duodenum of the recipient through an internal stent catheter. A 70% section of the native liver (left and medial hepatic lobes) was resected using bloodless hepatectomy. The mean operative duration was 154.5±16.4 min, and the warm and cold ischemia times of the graft were 8.1±1.1 min and 64.5±6.6 min, respectively. The blood flow of the arterialized portal vein to the graft was 1.8±0.3 ml/min/g liver weight. The success rate of model establishment (waking with post-surgical survival of >24 h) was 70% (7/10). Following successful model establishment, all rats survived 7 days post-surgery (100%; 7/7). The graft was found to be soft in texture and bright red in color following exploratory laparotomy. In conclusion, a new rat model of APHLT with LDABS without stent for vascular reconstruction was developed. This is a feasible and reliable rat model for liver transplantation study.

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Gastric variceal bleeding caused by an intrahepatic arterioportal fistula that formed after liver biopsy: a case report and review of the literature

Cited by 15 publications

References 30 publications

Gastric Variceal Bleeding Caused by an Arterioportal Fistula Formation After TIPS and Related Complications

Gastric Variceal Bleeding Caused by an Arterioportal Fistula Formation After TIPS and Related Complications

Hepatic Arterioportal Fistula Presenting as Gastric Variceal Hemorrhage

A new rat model of auxiliary partial heterotopic liver transplantation with liver dual arterial blood supply

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