Transhepatic Embolization of a Recanalized Congenital Hepatic Arterioportal Fistula with NBCA and Coils

Abstract

Congenital hepatic arterioportal fistula is a treatable cause of portal hypertension. Transarterial embolization is a widely accepted endovascular treatment approach. Here, a case of a recanalized congenital hepatic arterioportal fistula after prior transarterial coil embolization that was successfully treated with percutaneous transhepatic embolization with coils and N-butyl 2-cyanoacrylate is reported. The percutaneous transhepatic approach can be an effective alternative for patients with recanalized hepatic arterioportal fistula who have undergone prior transarterial coil embolization, and N-butyl 2-cyanoacrylate can be used as an embolic material in addition to metallic coils to achieve quick and total occlusion.

The Congenital Intrahepatic Arterioportal Fistula Syndrome

“…As shown in the present case, smaller branches with low flow can be effectively occluded with superselective injection of particulate or liquid embolic agents, such as particulate polyvinyl alcohol sponge (Ivalon) (36) or N-butyl 2-cyanoacrylate glue (66). Such materials can be combined with detachable metallic coils (66) and may be underused in IAPF.…”

Biliocutaneous Fistula Following Alveolar Hydatid Disease Surgery Treated Successfully With Percutaneous Cyanoacrylate

“…These cases particularly related to treatment of enteroenteric (1), enterovascular (2), bronchoesophageal (3,4), arteriovenous (5), and pancreatic fistulas (6)(7)(8). Our search of the literature revealed only a few cases concerning biliary leakages treated with cyanoacrylate, and these treatments were performed endoscopically (9, 10).…”

Congenital intrahepatic arterioportal fistula presenting as severe undernutrition and chronic watery diarrhea in a 2-year-old girl

“…Although it could not stop the symptoms of portal hypertension, the reduction of blood flow to the cut surface of liver during left lobe resection led to few hemodynamic disturbances, with no need for red blood cell transfusion. Although many authors recommend multiple TAEs as the best choice to treat complex IAPF [2,31,32], we believe that such procedures have a considerable risk of complications (as thrombosis of femoral artery and portal vein) [33], with a high percentage of failure or recurrence of symptoms. By the other hand, partial liver resections, performed by groups with great experience in hepatic surgery, may be a procedure with low rates of morbidity, even in cases of children with extreme undernutrition and other comorbidities [34].…”