Zastosowanie okludera naczyniowego Amplatzer do zamknięcia tętnicy wątrobowej jako metoda leczenia szybkoprzepływowej przetoki tętniczo-wrotnej przed przeszczepem wątroby.

Abstract

SummaryBackground:Arterioportal fistula (APF) is an abnormal, direct connection between hepatic artery or its branch and the portal vein. Fistula can be acquired or, rarely, congenital. One of the acquired causes of fistula is a liver biopsy. Patients with liver cirrhosis are particularly vulnerable to its development due to the large number of performed biopsies. APF increases mortality and morbidity of liver transplantation procedure and may be a contraindication to it. The authors present a patient with liver cirrhosis, in whom percutaneous APF closure facilitated liver transplantation.Case Report:We describe a case of a 50-year-old patient with liver cirrhosis and APF, probably formed as a result of liver biopsy. Due to the presence of a high-flow fistula, which elevated portal hypertension, patient did not qualify for the liver transplantation. Patient was transferred to the interventional radiology department, where the fistula’s vascular supply was endovascularly closed using the Amplatzer occluder. This subsequently enabled the execution of transplantation.Conclusions:Percutaneous closure of APF should be considered a relatively simple and fast-acting tool to facilitate or even enable liver transplant surgery. Currently, there are more and more products available such as e.g. Amplatzer occluder to simplify the procedure and shorten the duration of exposure to ionizing radiation.

Arterioportal Fistulas (APFs) in Pediatric Patients: Single Center Experience with Interventional Radiological versus Conservative Management and Clinical Outcomes

“…Transcatheter embolization was performed with different embolic materials, with coils being the most used, in accordance with the literature [24][25][26]. Microvascular plugs [27][28][29][30] were exceptionally used and, in our opinion, provided no advantages over coils. A point to consider is that to avoid shunt revascularization through collaterals, the APF feeding artery should be embolized upstream and downstream, as usually performed for aneurysms with the sandwich technique [31].…”