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A case of agnogenic intrahepatic arterioportal fistula complicated by gastric ulcer bleeding and progressive portal thrombosis

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Portal Hypertension & Cirrhosis 2022年第1期1卷 82-85页

作者： Siwei Yang Tianhao Su Zhiyuan Zhang Jianan Yu Long Jin Department of Interventional Radiology Beijing Friendship HospitalCapital Medical UniversityBeijingChina

arterioportal fistulas(APFs)are defined as vascular communications between the systemic arteries and portal circulation.APFs are classified as congenital or acquired,large or small,intrahepatic or extrahepatic,and traumatic or spontaneous.The consistent abnormal connection may result in severe presinusoidal portal hypertension,leading to gastrointestinal bleeding(GIB),ascites,elevated liver function enzymes,heart failure,diarrhea,and even pancreatitis or hematobilia in some unusual cases.Indeed,less than half reported cases have GIB,predominately caused by variceal rupture.Peptic ulcer bleeding has rarely been reported in the setting of APFs.Herein,we describe a case in which intrahepatic APF manifested as gastric ulcer bleeding,progressive portal thrombosis,and massive ascites,with these symptoms successfully relieved by endovascular treatment.

关键词： arterial bleeding arterial embolization arterioportal fistula portal hypertension portal thrombosis

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Coil embolization of arterioportal fistula complicated by gastrointestinal bleeding after Caesarian section: A case report

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World Journal of Clinical Cases 2021年第2期9卷 403-409页

作者： Suren Agho Stepanyan Tigran Poghosyan Karen Manukyan Gagik Hakobyan Hayk Hovhannisyan Hayk Safaryan Elena Baghdasaryan Manik Gemilyan Department of Surgery No.1 Yerevan State Medical UniversityYerevan 0025Armenia Department of Vascular Surgery National Center of OncologyYerevan 0052Armenia Department of Endoscopy Mikaelyan University HospitalYerevan 0052Armenia Department of Gastroenterology and Hepatology Yerevan State Medical UniversityYerevan 0025Armenia Department of Surgery Masis Medical CenterMasis 0801Armenia Department of Surgery Mikaelyan Institute of SurgeryYerevan 0052Armenia Department of Radiology Armenia Medical CenterYerevan 0078Armenia

BACKGROUND Most intrahepatic arterioportal fistulae(IAPF)are acquired.The few cases of congenital fistulae are diagnosed in infants and children.CASE SUMMARY We report a 31-year-old female patient presenting with haematemesis and melena three weeks after delivering her second child.The patient had a 20-year history of abdominal distention and nausea.IAPF,along with splenomegaly and ascites,was found by Doppler sonography and confirmed by computed tomography angiography.The patient was treated with endovascular coil embolization,resulting in occlusion of the fistula.CONCLUSION This was an unusual case of possible congenital IAPF that manifested during a second pregnancy and was complicated by portal hypertension.

关键词： Intrahepatic fistula Coil embolization Portal hypertension Case report Occlusion arterioportal fistula

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Comparison of ethanol-soaked gelatin sponge and microspheres for hepatic arterioportal fistulas embolization in hepatic cellular carcinoma

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World Journal of Gastrointestinal Oncology 2023年第9期15卷 1595-1604页

作者： Guang-Sheng Yuan Li-Li Zhang Zi-Tong Chen Cun-Jing Zhang Shu-Hui Tian Ming-Xia Gong Peng Wang Lei Guo Nan Shao Bin Liu Institute of Interventional Oncology Shandong UniversityJinan 250033Shandong ProvinceChina Department of Radiology Dongying Traditional Chinese Medicine HospitalDongying 257055Shandong ProvinceChina Department of Gastroenterology People's Hospital of Qihe CountyDezhou 251100Shandong ProvinceChina Department of Interventional Medicine The Second Hospital of Shandong UniversityJinan 250033Shandong ProvinceChina Dean’s Office Jinan Vocational College of NursingJinan 250100Shandong ProvinceChina Department of Interventional Medicine People’s Hospital of Zouping CityBinzhou 256299Shandong ProvinceChina Department of Vascular Anomalies and Interventional Radiology Qilu Children’s Hospital of Shandong UniversityJinan 250022Shandong ProvinceChina

Hepatic arterioportal fistulas(APFs)are common in hepatocellular carcinoma(HCC).Moreover,correlated with poor prognosis,APFs often complicate antitumor treatments,including transarterial chemoembolization(TACE).AIM To compare the efficacy of ethanol-soaked gelatin sponges(ESG)and microspheres in the management of APFs and their impact on the prognosis of HCC.METHODS Data from patients diagnosed with HCC or hepatic APFs between June 2016 and December 2019 were retrospectively analyzed.Furthermore,APFs were embolized with ESG(group E)or microspheres(group M)during TACE.The primary outcomes were disease control rate(DCR)and objective response rate(ORR).The secondary outcomes included immediate and first follow-up APF improvement,overall survival(OS),and progression-free survival(PFS).RESULTS Altogether,91 participants were enrolled in the study,comprising 46 in group E and 45 in group M.The DCR was 93.5%and 91.1%in groups E and M,respectively(P=0.714).The ORRs were 91.3%and 66.7%in groups E and M,respectively(P=0.004).The APFs improved immediately after the procedure in 43(93.5%)patients in group E and 40(88.9%)patients in group M(P=0.485).After 2 mo,APF improvement was achieved in 37(80.4%)and 33(73.3%)participants in groups E and M,respectively(P=0.421).The OS was 26.2±1.4 and 20.6±1.1 mo in groups E and M,respectively(P=0.004),whereas the PFS was 16.6±1.0 and 13.8±0.7 mo in groups E and M,respectively(P=0.012).CONCLUSION Compared with microspheres,ESG embolization demonstrated a higher ORR and longer OS and PFS in patients of HCC with hepatic APFs.

关键词： Hepatocellular carcinoma arterioportal fistula Ethanol Gelatin sponge Microsphere Embolization

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