Hepatic arterioportal fistula related to a liver biopsy

Baer, Jeanne W.

doi:10.1007/bf02256508

Cited by 13 publications

(4 citation statements)

References 15 publications

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“…From among the English language reports, clinically symptomatic cases following percutaneous liver biopsy were selected (Table 1) [4, 6–29]. A case observed in our unit was also added to the review.…”

Section: Discussionmentioning

confidence: 99%

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

Iwaki

Matsuda

Yoshida

et al. 2012

Clin J Gastroenterol

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An intrahepatic arterioportal fistula is a rare cause of portal hypertension and variceal bleeding. We report on a patient with an intrahepatic arterioportal fistula following liver biopsy who was successfully treated by hepatectomy after unsuccessful arterial embolization. We also review the literature on symptomatic intrahepatic arterioportal fistulas after liver biopsy. A 48-year-old male with bleeding gastric varices and hepatitis B virus-associated liver cirrhosis was transferred to our hospital; this patient previously underwent percutaneous liver biopsies 3 and 6 years ago. Abdominal examination revealed a bruit over the liver, tenderness in the right upper quadrant, and splenomegaly. Ultrasonographic examination, computed tomography, and angiography confirmed an arterioportal fistula between the right hepatic artery and the right portal vein with portal hypertension. After admission, the patient suffered a large hematemesis and developed shock. He was treated with emergency transarterial embolization using microcoils. Since some collateral vessels bypassed the obstructive coils and still fed the fistulous area, embolization was performed again. Despite the second embolization, the collateral vessels could not be completely controlled. Radical treatment involving resection of his right hepatic lobe was performed. For nearly 6 years postoperatively, this patient has had no further episodes of variceal bleeding.

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Section: Discussionmentioning

confidence: 99%

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

Iwaki

Matsuda

Yoshida

et al. 2012

Clin J Gastroenterol

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“… 1 Although smaller fistulas may thrombose spontaneously, larger fistulas and those close to the porta hepatis can cause clinically significant portal hypertension. 2 Transarterial coil embolization is first-line treatment, with alternatives including n -butyl-2-cyanoacrylate embolization, hepatic artery ligation, or partial hepatectomy. 1 …”

Section: Case Reportmentioning

confidence: 99%

Intrahepatic Arterioportal Fistula With Subsequent Portal Hypertension After Percutaneous Liver Biopsy

Dawkins,

Cheung,

Rozenblit

et al. 2024

ACG Case Rep J

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Percutaneous liver biopsy was performed, revealing noncirrhotic autoimmune hepatitis. Immunosuppression was initiated, and liver chemistries improved. Five years later, she developed new onset massive ascites and a recurrent hepatic hydrothorax. Abdominopelvic computed tomography revealed a left lobe intrahepatic arterioportal fistula (APF) with regional parenchymal atrophy. Angiography visualized the hepatic artery (orange arrow) with immediate left portal vein opacification (green arrow) and compromised blood flow to the left lobe, confirming an APF (Figure 1). Catheterization of the proper hepatic and left hepatic arteries was performed with successful APF coil embolization. Postoperative angiography showed successful fistula coil occlusion (red arrow) without compromised perfusion to the right or left lobes (Figure 2). Follow-up evaluation noted resolution of her portal hypertension, ascites, and hydrothorax. Intrahepatic APFs are rare complications of percutaneous and transjugular liver biopsies. 1 Although smaller fistulas may thrombose spontaneously, larger fistulas and those close to the porta hepatis can cause clinically significant portal hypertension. 2 Transarterial coil embolization is first-line treatment, with alternatives including n-butyl-2-cyanoacrylate embolization, hepatic artery ligation, or partial hepatectomy. 1

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“…Although RFA appears minimally invasive and comparatively safe, it often causes complications such as intraperitoneal bleeding [ 5 , 6 ]. Arterioportal fistula (APF) commonly occurs either secondary to iatrogenic causes, such as liver biopsy, transhepatic biliary drainage, transhepatic cholangiogram, and surgery, or following mechanical insult, such as blunt or penetrating trauma [ 7 , 8 , 9 , 10 , 11 ]. APF usually remains clinically asymptomatic at the outset of the formation.…”

Section: Introductionmentioning

confidence: 99%

Successful Interventional Treatment for Arterioportal Fistula Caused by Radiofrequency Ablation for Hepatocellular Carcinoma

et al. 2014

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Radiofrequency ablation (RFA) is commonly used as a treatment for small hepatocellular carcinoma (HCC). Although several complications such as intraperitoneal bleeding are often observed after RFA, hepatic arterioportal fistula (APF) is a less frequently occurring complication. In this study, we describe two cases of APF caused by RFA, which was successfully occluded by an interventional approach. Case 1 involved a 68-year-old man with solitary HCC in segment VIII of the liver. Both contrast-enhanced computed tomography and color Doppler sonography indicated an APF between the anterosuperior branch of the right hepatic artery (A8) and the portal branch (P8). Concordant with these findings, digital subtraction angiography (DSA) revealed an APF in segment VIII of the liver. Subsequently, the APF was successfully occluded by transarterial embolization (TAE) using gelatin sponge particles. Case 2 involved a 67-year-old man with solitary HCC in segment VII of the liver. Although he developed obstructive jaundice because of hemobilia after RFA, it was improved by endoscopic nasobiliary drainage and the systemic administration of antibiotics. In addition, color Doppler sonography revealed a disturbed flow of the right branch of the portal vein. Similar to case 1, DSA showed an APF between A8 and P8. The APF was successfully embolized by TAE using microcoils. In conclusion, it appears that the formation of APF should be checked after RFA. It is preferable to treat RFA-induced APF promptly by an interventional approach to avoid secondary complications such as portal hypertension and liver dysfunction.

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Hepatic arterioportal fistula related to a liver biopsy

Cited by 13 publications

References 15 publications

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

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

Intrahepatic Arterioportal Fistula With Subsequent Portal Hypertension After Percutaneous Liver Biopsy

Successful Interventional Treatment for Arterioportal Fistula Caused by Radiofrequency Ablation for Hepatocellular Carcinoma

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