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Endoluminal Management of Arterioportal Fistulae in Liver Transplant Recipients: A Single-Center Experience

Department of Imaging Sciences, Section of Vascular/Interventional Radiology, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642; wspikes{at}yahoo.com

Mark G. Davies, MD, PhD

Department of Surgery, Division of Vascular Surgery, University of Rochester Medical Center, Rochester, New York

Deborah J. Rubens, MD

Department of Body and Cross-Sectional Imaging, University of Rochester Medical Center, Rochester, New York

Lawrence G. Sahler, MD

Nikhil C. Patel, MD

David E. Lee, MD

Takashi Kitanosono, MD

Talia Sasson, MD

David L. Waldman, MD, PhD

Department of Imaging Sciences, Sections of Vascular/Interventional Radiology, University of Rochester Medical Center, Rochester, New York

Transcatheter embolization of arterioportal fistulae in liver transplant recipients is restricted to symptomatic arterioportal fistulae. Angiograms of liver transplant recipients from a single university medical center were retrospectively reviewed. Hemodynamically significant arterioportal fistulae were defined as those exhibiting opacification of the main portal vein of the transplanted hepatic graft or its first order branch with or without portal venous changes by Doppler ultrasound imaging. Six arterioportal fistulae were found. Doppler ultrasound imaging detected 50% of all arterioportal fistulae and all 3 hemodynamically significant arterioportal fistulae. Three successful embolizations were performed. Follow-up (37 to 67 months) demonstrated patent hepatic arteries and no parenchymal ischemic changes with graft preservation. High-throughput arterioportal fistulae may require larger intrahepatic artery branch embolization. There is a window of opportunity for embolizing significant arterioportal fistulae before their progression to large symptomatic, high through-put arterioportal fistulae with their added risk of ischemic changes before and after embolization.

Key Words: arterioportal fistulae • embolization • Doppler ultrasound

Vascular and Endovascular Surgery, Vol. 40, No. 6, 451-459 (2007)
DOI: 10.1177/1538574406294072


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