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Sanomura T, Norikane T, Uchinomura S, Takami Y, Ensako T, Nagao M, Deguchi A, Okano K, Nishiyama Y. Omental arteriovenous fistula after splenectomy treated with transarterial embolization. CVIR Endovasc 2023; 6:28. [PMID: 37099195 PMCID: PMC10133414 DOI: 10.1186/s42155-023-00374-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/18/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Laparoscopic splenectomy for patients with portal hypertension is associated with a high risk of bleeding. The use of vessel-sealing devices and automatic sutures is important for bleeding control. However, a rare complication of abdominal surgery is the direct communication between the arterial and portal circulation related to surgical procedures such as simultaneous ligature of an artery and adjacent vein. We describe a rare case of omental arteriovenous fistula (AVF) after laparoscopic splenectomy treated with transarterial embolization. CASE PRESENTATION We report a case of a 46-year-old male patient with an omental AVF after a laparoscopic splenectomy 6 years ago for splenomegaly associated with alcoholic cirrhosis. Follow-up abdominal dynamic computed tomography accidentally revealed a vascular sac (25 mm in the major axis) that formed an omental AVF with anastomosis to the left colonic vein. The communication was considered to be caused by using a vessel-sealing device. No symptoms related to the AVF were observed. The AVF was embolized with microcoils using the transarterial approach. A 4-axis catheter system was used for accurate embolization due to the long and tortuous distance from the celiac artery. No recurrence or symptoms were observed after 6 months. CONCLUSIONS Treatment of arterioportal fistula is mandatory, even in asymptomatic patients. Embolization is a less invasive alternative to surgical approaches. The 4-axis catheter system was useful for accurate embolization via a long and tortuous artery.
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Affiliation(s)
- Takayuki Sanomura
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Cho, Kita-Gun, Kagawa, 761-0793, Japan.
| | - Takashi Norikane
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Cho, Kita-Gun, Kagawa, 761-0793, Japan
| | - Satoshi Uchinomura
- Department of Radiology, Kagawa Rousai Hospital, 3-3-1, Joutou, Marugame, Kagawa, 763-8502, Japan
| | - Yasukage Takami
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Cho, Kita-Gun, Kagawa, 761-0793, Japan
| | - Toshiya Ensako
- Department of Radiology, Kagawa Rousai Hospital, 3-3-1, Joutou, Marugame, Kagawa, 763-8502, Japan
| | - Mina Nagao
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Cho, Kita-Gun, Kagawa, 761-0793, Japan
| | - Akihiro Deguchi
- Department of Gastroenterology, Kagawa Rousai Hospital, 3-3-1, Joutou, Marugame, Kagawa, 763-8502, Japan
| | - Keiichi Okano
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Cho, Kita-Gun, Kagawa, 761-0793, Japan
| | - Yoshihiro Nishiyama
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Cho, Kita-Gun, Kagawa, 761-0793, Japan
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Anand RR, Cherian P M, Mehta P, Gandhi JM, S E, Patil SB. Endovascular treatment of psuedoaneurysm arising from common hepatic artery bifurcation with complete disruption of gastroduodenal artery and high flow arterioportal fistula. Ann Hepatobiliary Pancreat Surg 2019; 23:187-191. [PMID: 31225423 PMCID: PMC6558136 DOI: 10.14701/ahbps.2019.23.2.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/01/2019] [Accepted: 02/07/2019] [Indexed: 11/19/2022] Open
Abstract
Arterio-portal fistulas (APFs) are characterized by anomalous communication between arteries and the portal vein (PV) system. Treatment of APF is imperative as an emergency or if there is development of portal hypertension/heart failure in chronic cases. Both endovascular and surgical managements can be attempted, however since endovascular management carries comparatively low intra and post procedural morbidity it is mostly preferred. This is a case report on endovascular management of post-traumatic pseudoaneurysm arising from bifurcation of common hepatic artery with complete disruption of the gastroduodenal artery and high-flow APF. This report describes the intraprocedure challenges in exclusion of fistula from the circulation, without disruption of portal system and anticipation of recruitment of new collateral feeders to the fistula immediate post exclusion with its embolization, which needs appropriate positioning of the catheter prior to exclusion of the fistula.
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Affiliation(s)
- Rinoy R Anand
- Department of Neuro and Vascular Interventional Radiology, Kovai Medical Center and Hospital Coimbatore, Tamil Nadu, India
| | - Mathew Cherian P
- Department of Neuro and Vascular Interventional Radiology, Kovai Medical Center and Hospital Coimbatore, Tamil Nadu, India
| | - Pankaj Mehta
- Department of Neuro and Vascular Interventional Radiology, Kovai Medical Center and Hospital Coimbatore, Tamil Nadu, India
| | - Jenny M Gandhi
- Department of Neuro and Vascular Interventional Radiology, Kovai Medical Center and Hospital Coimbatore, Tamil Nadu, India
| | - Elango S
- Department of Neuro and Vascular Interventional Radiology, Kovai Medical Center and Hospital Coimbatore, Tamil Nadu, India
| | - Santosh B Patil
- Department of Neuro and Vascular Interventional Radiology, Kovai Medical Center and Hospital Coimbatore, Tamil Nadu, India
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Kimura Y, Hori T, Machimoto T, Ito T, Hata T, Kadokawa Y, Kato S, Yasukawa D, Aisu Y, Takamatsu Y, Kitano T, Yoshimura T. Portal vein aneurysm associated with arterioportal fistula after hepatic anterior segmentectomy: Thought-provoking complication after hepatectomy. Surg Case Rep 2018; 4:57. [PMID: 29904893 PMCID: PMC6002328 DOI: 10.1186/s40792-018-0465-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/04/2018] [Indexed: 11/17/2022] Open
Abstract
Background Few cases of postoperative arterioportal fistula (APF) have been documented. APF after hepatectomy is a very rare surgery-related complication. Case presentation A 62-year-old man was diagnosed with hepatocellular carcinoma in segments 5 and 8, respectively. Anterior segmentectomy was performed as a curative surgery. Each branch of the hepatic artery, portal vein, and biliary duct for the anterior segment was ligated together as the Glissonean bundle. The patient was discharged on postoperative day 14. Three months later, dynamic magnetic resonance imaging showed an arterioportal fistula and portal vein aneurysm. Surprisingly, the patient did not have subtle symptoms. Although a perfect angiographic evaluation could not be ensured, we performed angiography with subsequent interventional radiology to avoid sudden rupture. Arteriography was immediately performed to create a portogram via the APF from the stump of the anterior hepatic artery, and portography clearly revealed hepatofugal portal vein flow. Portography also showed that the stump of the anterior portal vein had developed a 40-mm-diameter portal vein aneurysm. Selective embolization of the anterior hepatic artery was accomplished in the whole length of the stump of the anterior hepatic artery, and abnormal blood flow through the APF was drastically reduced. The portal vein aneurysm disappeared, and portal flow was normalized. Dynamic computed tomography after embolization clearly demonstrated perfect interruption of the APF. The patient maintained good health thereafter. Conclusions Post-hepatectomy APFs are very rare, and some appear to be cryptogenic. Our thought-provoking case may help to provide a possible explanation of the causes of post-hepatectomy APF.
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Affiliation(s)
- Yusuke Kimura
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan.
| | - Tomohide Hori
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan.
| | - Takafumi Machimoto
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Tatsuo Ito
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Toshiyuki Hata
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Yoshio Kadokawa
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Shigeru Kato
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Daiki Yasukawa
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Yuki Aisu
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Yuichi Takamatsu
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Taku Kitano
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Tsunehiro Yoshimura
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
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Endovascular treatment of an unusual primary arterioportal fistula complicated by cavernous transformation of the portal vein caused by portal thrombosis. Ann Vasc Surg 2013; 28:491.e5-8. [PMID: 24368181 DOI: 10.1016/j.avsg.2012.10.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 10/09/2012] [Accepted: 10/12/2012] [Indexed: 01/26/2023]
Abstract
We describe an elderly woman who presented with an unusual primary arterioportal fistula and cavernous transformation of the portal vein caused by portal thrombosis, which were subsequently managed with endovascular coil embolization and transjugular intrahepatic portosystemic shunt using 2 stents after balloon remodeling. This case shows a rarely seen condition in the elderly and a novel management strategy that should be considered in the management of this complex disease.
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Nie L, Luo XF, Li X. Gastrointestinal bleeding caused by extrahepatic arterioportal fistula associated with portal vein thrombosis. World J Gastroenterol 2012; 18:6501-6503. [PMID: 23197898 PMCID: PMC3508647 DOI: 10.3748/wjg.v18.i44.6501] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
An extrahepatic arterioportal fistula (APF) involving the gastroduodenal artery and superior mesenteric vein is rare and mostly results from iatrogenic injuries. The clinical symptoms associated with APFs may include abdominal pain, gastrointestinal bleeding, ascites, nausea, vomiting, diarrhea, or even congestive heart failure. We present the case of a 70-year-old man who presented with chronic abdominal pain and gastrointestinal bleeding secondary to APF and portal vein thrombosis. The endovascular embolization of APF was accomplished successfully, and symptoms of portal hypertension resolved immediately after intervention. Unfortunately, the patient did not respond well to anticoagulation therapy with warfarin. Therefore, the patient underwent implantation of a transjugular intrahepatic portosystemic shunt, and the complications of portal hypertension resolved. In conclusion, the embolization of APF is technically feasible and effective and can be considered the first-choice therapy in selected patients.
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