Isobutyl 2-cyanoacrylate embolization of a hepatoportal fistula

Ramchandani, Parvati; Goldenberg, NJ; Rl, Soulen; White, R I

doi:10.2214/ajr.140.1.137

Cited by 25 publications

(14 citation statements)

References 14 publications

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“…Hemobilia remains a challenging clinical problem today in light of the prevalence of diagnostic and therapeutic transhepatic invasive procedures, such as percutaneous transhepatic cholangiography, PBD procedures, and transhepatic biopsies [1,2,[4][5][6][7].…”

Section: Discussionmentioning

confidence: 99%

“…It is often helpful to remove or manipulate transhepatic biliary drainage catheters prior to performing angiography because these may tamponade bleeding sites [8]. In addition to the occasional demonstration of active extravasation of contrast material into the biliary tree, angiography may also reveal the underlying etiology, including hepatic artery aneurysm, pseudoaneurysm, or arterioportal or arteriobiliary fistula [2][3][4][5][6][7].…”

Section: Discussionmentioning

confidence: 99%

“…Most cases of hemobilia seen today are iatrogenic, due to invasive percutaneous hepatobiliary procedures or liver biopsies, and are often treatable with transarterial embolization [1][2][3][4][5][6][7]. All previously reported cases of hemobilia have been due to intrahepatic abnormalities.…”

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Arteriocholedochal fistula: an unusual cause of hemobilia

1996

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Arteriocholedochal fistula: an unusual cause of hemobilia

1996

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“…Other causes include tumor invasion of the two vessels, cirrhosis. congenital arteriovenous malformations, 3 and various transhepatic manipulations procedures. n.fl These do not apply in this case.…”

Section: Discussionmentioning

confidence: 99%

“…Hepatic arteriogr.lphy can then be planned with preparation for possible embolizntion of the fistula . 3 …”

Section: Discussionmentioning

confidence: 99%

Arterioportal fistula demonstrated by pulsed Doppler ultrasonography.

Lafortune¹,

Breton²,

Charlebois³

1986

Journal of Ultrasound in Medicine

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Arterioportal fistulae are usually silent clinically until complications of portal hypertension occur. \Ve present the case of a 60-year-old man with an abdominal bruit appearing 4V2 years after a splenectomy and aortic aneurysm repair and suspected to be caused by an aorto-caval 6stula. Pulsed Doppler ultrasonography detected a large hepatic arteriovenous 6stulu, confirmed hv dvnumic computed tomography and angiography. • REPORT OF A CASEA 60-year-old man underwent aorto-hifcmoral bypass for a saccular aneurvsm of the abdominal aorta. At the time of surgery, splcncctomy was performed to correct hypersplcnism and two needle biopsies were ohtaim:!d from the lel'i: lobe and a wedge biopsy from the right Johe of the liver to rule out a clinically suspected lymphoma. The inforior vena cava was laccmtecl and repaired. There were no immediate postoperative compli• cations . Four and a half years later, he developed c; c -ardiac failure. A right upper quadrant abdominal bruit was heard. Heal -time ultrasound examination disclosed a normal inferior vena cava and un aneurvsm of the abdominal aorta. The left branch of the 1;ortul vein was grossly dilated as was what was presumed to he and, at Doppler investigation, proven to be the left hepatic artery! ( fig. 1).A fistula between the left hepntic nnd the left portal vein was suspected. Pulsed Doppler examination showed greatly turbulent high velocity, bidirectional, systolodiastolic flow at the site of the fistula {fig. lB) and a normal direction of the hlood flow in the remainder of the portal system .IiThere was no ascitcs. No other signs of portal hypertension were seen .Dynamic computed tomography showed simultaneous opacification of the left hepatic arter)' and intrahcpatic portal vein ( fig. 2). There was an increased "'onccn trntion of' contrast in the left hepatic Johe . e c onda ry to prcfcrentiul left hlood supply {fig. 28).Abdominal aortography confirmed the intrahepatic ar· tcriovenous fistuln. DISCUSSIONHepatoportal 6stulae are usually the result of rupture of a pre-existing hepatic artery aneurysm, 3A trauma;' or previous biopsy.s In our pa- tient the left hepatic needle biopsies performed 4V~ years earlier probably caused the fistula. Other causes include tumor invasion of the two vessels, cirrhosis. congenital arteriovenous malformations, 3 and various transhepatic manipulations procedures. n.fl These do not apply in this case. An aortognun done prior to the aneurysm repair lmd shown normal hepatic arteries.Our patient had not yet developed the most common presenting clinical foatures of in trahepatic arterio-portal fistula, those of portal hypertension. 3 ·fl He presented with high output cardiac failure, a relatively rare complication of this type of fistuln.; At the time of discovcrv of his abdominal bruit, the latter was assumed to ~l ri se from an iatrogenic :wrtocuval fistula . The ultrasonographic find ings were thus a surprise. The Doppler results are classic for an artcriovenous fistula: bidirectional systolodiastolic flow at the site of the fistu...

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Angiographic embolization of intrahepatic arterioportal fistula

Romeo

Herrera

Picouto

1991

Journal of British Surgery

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Case reportA 35-year-old woman presented with upper gastrointestinal haemorrhage in September 1989. Four years earlier, chronic active hepatitis (HbAg+) had been diagnosed by percutaneous liver biopsy, the procedure being remembered as especially painful. She had no previous history of gastrointestinal bleeding, blood transfusion, alcoholism or drug addiction. Physical examination revealed moderate ascites and splenomegaly, although the blood biochemical determinations, coagulation studies and leucocyte and platelet counts were normal. Endoscopy showed large bleeding oesophageal varices which were successfully sclerosed. Ultrasonography demonstrated a central anechoic lesion in the right lobe of the liver which was interpreted as a cyst. The patient rebled from oesophageal varices 1 month later and endoscopic variceal sclerotherapy was again successful. Portohepatic echo-Doppler examination revealed hepatofugal blood flow. Splanchnic and hepatic angiography (October 1989) demonstrated a hypertrophied and tortuous hepatic artery feeding a very active intrahepatic pseudoaneurysmal arterioportal fistula located centrally in the right lobe, with immediate retrograde filling of the portal vein ( Figure I ) and reflux to the left gastric vein, with extensive collateral circulation through the oesophageal and perisplenic vascular beds. The fistula was embolized with four Gianturco (occluding string embolus, William Cook Europe, Denmark) coils. On control angiography 15 days later the fistula and its aneurysmic dilatations had disappeared ( Figure Z), and there were fewer arteriographic signs of portal hypertension. Echo-Doppler examination showed hepatopetal portal blood flow. Percutaneous liver biopsy demonstrated chronic active hepatitis and portal fibrosis.When the patient was reviewed 6 months later she was asymptomatic and routine analyses were normal. Endoscopy revealed less prominent oesophageal varices. Digital angiographic studies (April 1990) showed revascularization of the intrahepatic arterioportal fistulous sinus with filling of the portal vein in the early arterial phase and retrograde portal blood flow (Figure 3). Embolization was performed again with five Gianturco coils, almost eliminating the fistula, although some collateral vessels from the right hepatic artery or even from the left hepatic artery (which arose from the left gastric artery) bypassed the obstructive coils and still fed the fistulous area.

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Isobutyl 2-cyanoacrylate embolization of a hepatoportal fistula

Cited by 25 publications

References 14 publications

Arteriocholedochal fistula: an unusual cause of hemobilia

Arteriocholedochal fistula: an unusual cause of hemobilia

Arterioportal fistula demonstrated by pulsed Doppler ultrasonography.

Angiographic embolization of intrahepatic arterioportal fistula

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