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Semin intervent Radiol 2012; 29(02): 105-110
DOI: 10.1055/s-0032-1312571
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Arterioportal Fistulas in Liver Transplant Recipients

Wael E. A. Saad
1   Division of Vascular Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
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Publication Date:
14 June 2012 (online)

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Abstract

Arterioportal fistulas (APFs) are classified into intrahepatic (>75% of all reported) and extrahepatic (<25% of all reported ). Anecdotally, investigators are more likely to report more sensational cases (typically extrahepatic APFs), so the actual prevalence of intrahepatic APFs is probably much higher (likely >90% of APFs). All reported APFs in liver transplant recipients have been intrahepatic. Hemodynamically significant APFs in liver transplant recipients are rare, occurring in 0.2%; however, APFs (hemodynamically significant or not) are not uncommonly seen in hepatic angiograms of liver transplant recipients (up to 5.4% of hepatic arteriograms in transplants). Interestingly, hemodynamically significant APFs warranting endovascular treatment are reported more commonly in the literature in native compared with transplanted livers (n >280–300 versus n = 13, respectively). This article discusses APFs that are specific to liver transplant recipients; their incidence, etiology, pathogenesis, natural history, clinical presentation, and endovascular management are discussed in detail.

Keywords

transplant - liver - vascular complications - endovascular - portal - arterial - fistula - embolization
 

  • References

  • 1 Saad WE, Davies MG, Rubens DJ , et al. Endoluminal management of arterioportal fistulae in liver transplant recipients: a single-center experience. Vasc Endovascular Surg 2006; 40 (6) 451-459
    PubMedGoogle Scholar
  • 2 Saad WE, Lippert AJ, Davies MG , et al. Prevalence, presentation, and endovascular management of hemodynamically or clinically significant arterio-portal fistulae in living- and cadaveric-donor liver transplant recipients. Clin Transpl In press
    PubMedGoogle Scholar
  • 3 Saad WE. Management of nonocclusive hepatic artery complications after liver transplantation. Tech Vasc Interv Radiol 2007; 10 (3) 221-232
    CrossrefPubMedGoogle Scholar
  • 4 Saad WE, Lin E, Ormanoski M, Darcy MD, Rubens DJ. Noninvasive imaging of liver transplant complications. Tech Vasc Interv Radiol 2007; 10 (3) 191-206
    CrossrefPubMedGoogle Scholar
  • 5 Wozney P, Zajko AB, Bron KM, Point S, Starzl TE. Vascular complications after liver transplantation: a 5-year experience. AJR Am J Roentgenol 1986; 147 (4) 657-663
    CrossrefPubMedGoogle Scholar
  • 6 Zajko AB, Bron KM, Starzl TE , et al. Angiography of liver transplantation patients. Radiology 1985; 157 (2) 305-311
    PubMedGoogle Scholar
  • 7 Karatzas T, Lykaki-Karatzas E, Webb M , et al. Vascular complications, treatment, and outcome following orthotopic liver transplantation. Transplant Proc 1997; 29 (7) 2853-2855
    CrossrefPubMedGoogle Scholar
  • 8 Jabbour N, Reyes J, Zajko A , et al. Arterioportal fistula following liver biopsy. Three cases occurring in liver transplant recipients. Dig Dis Sci 1995; 40 (5) 1041-1044
    CrossrefPubMedGoogle Scholar
  • 9 Portal A. Mémoires sur quelques maladies du foie, qu'on attribue à d'autres organes et sur des maladies dont on fixe ordinairement le siège dans le foie quoi qu'il n'y soit pas. Histoire de l'Académie Royale Sciences, année 1777, 1780:601
    PubMedGoogle Scholar
  • 10 Figueras J, Soubrane O, Pariente D, Devictor D, Houssin D. Fatal hemobilia after liver graft biopsy in a transplanted child. Gastroenterol Clin Biol 1994; 18 (8–9) 786-788
    PubMedGoogle Scholar
  • 11 Saad WE. Management of nonocclusive hepatic artery complications after liver transplantation. Tech Vasc Interv Radiol 2007; 10 (3) 221-232
    CrossrefPubMedGoogle Scholar
  • 12 Saad WE, Davies MG, Ryan CK , et al. Incidence of arterial injuries detected by arteriography following percutaneous right-lobe ultrasound-guided core liver biopsies in human subjects. Am J Gastroenterol 2006; 101 (11) 2641-2645
    CrossrefPubMedGoogle Scholar
  • 13 Hellekant C. Vascular complications following needle puncture of the liver. Clinical angiography. Acta Radiol Diagn (Stockh) 1976; 17 (2) 209-222
    PubMedGoogle Scholar
  • 14 Okuda K, Musha H, Nakajima Y , et al. Frequency of intrahepatic arteriovenous fistula as a sequela to percutaneous needle puncture of the liver. Gastroenterology 1978; 74 (6) 1204-1207
    PubMedGoogle Scholar
  • 15 Hellekant C, Olin T. Vascular complications following needle puncture of the liver. An angiographic investigation in the rabbit. Acta Radiol Diagn (Stockh) 1973; 14 (5) 577-582
    PubMedGoogle Scholar
  • 16 Chavan A, Harms J, Pichlmayr R, Galanski M. Transcatheter coil occlusion of an intrahepatic arterioportal fistula in a transplanted liver. Bildgebung 1993; 60 (4) 215-218
    PubMedGoogle Scholar
  • 17 Vivas S, Palacio MA, Lomo J , et al. Arterioportal fistula and hemobilia in a patient with hepatic transplant [in Spanish]. Gastroenterol Hepatol 1998; 21 (2) 88-89
    PubMedGoogle Scholar
  • 18 Charco R, Margarit C, López-Talavera JC , et al. Outcome and hepatic hemodynamics in liver transplant patients with portal vein arterialization. Am J Transplant 2001; 1 (2) 146-151
    CrossrefPubMedGoogle Scholar
  • 19 Botelberge T, Van Vlierberghe H, Voet D, Defreyne L. Detachable balloon embolization of an arterioportal fistula following liver biopsy in a liver transplant recipient: a case report and review of literature. Cardiovasc Intervent Radiol 2005; 28 (6) 832-835
    CrossrefPubMedGoogle Scholar
  • 20 Detry O, De Roover A, Delwaide J, Dondelinger RF, Meurisse M, Honoré P. Selective coil occlusion of a large arterioportal fistula in a liver graft. Liver Transpl 2006; 12 (5) 888-889
    CrossrefPubMedGoogle Scholar
  • 21 Otobe Y, Hashimoto T, Shimizu Y , et al. Formation of a fatal arterioportal fistula following needle liver biopsy in a child with a living-related liver transplant: report of a case. Surg Today 1995; 25 (10) 916-919
    CrossrefPubMedGoogle Scholar
  • 22 Chua DY, Pavillion G, Tay KH, Tan JL, Chung AY. Pulmonary hypertension: an unusual presentation of an iatrogenic hepatic arterioportal fistula and its successful resolution post-embolotherapy. Am Surg 2009; 75 (6) 511-514
    PubMedGoogle Scholar
  • 23 Strodel WE, Eckhauser FE, Lemmer JH, Whitehouse Jr WM, Williams DM. Presentation and perioperative management of arterioportal fistulas. Arch Surg 1987; 122 (5) 563-571
    CrossrefPubMedGoogle Scholar
  • 24 Agha FP, Raji MR. Successful transcatheter embolic control of significant arterioportal fistula: a serious complication of liver biopsy. Br J Radiol 1983; 56 (664) 277-280
    CrossrefPubMedGoogle Scholar
  • 25 Saad WE. Management of hepatic artery steno-occlusive complications after liver transplantation. Tech Vasc Interv Radiol 2007; 10 (3) 207-220
    CrossrefPubMedGoogle Scholar
  • 26 Saad WE, Davies MG, Sahler LG , et al. Hepatic artery stenosis in liver transplant recipients: primary treatment with percutaneous transluminal angioplasty. J Vasc Interv Radiol 2005; 16 (6) 795-805
    CrossrefPubMedGoogle Scholar