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Published on: July 11, 2013
Acute ischemic hepatitis in aortocaval fistula
G Sobrinho1, M E Ferreira, J P Albino
1Department of Vascular Surgery, Hospital de Santa Marta, Lisboa, Portugal. gsobrinho@netscape.net
Insights
Aortocaval fistula can cause acute ischemic hepatitis, marked by high liver enzymes and creatinine. This liver dysfunction is a common complication but benign, resolving after surgery.
Area of Science:
- Vascular Surgery
- Hepatology
- Nephrology
Background:
- Aortocaval fistula is a rare but serious complication.
- Liver dysfunction can occur in patients with aortocaval fistula.
- Characterizing this dysfunction is important for patient management.
Purpose of the Study:
- To characterize liver dysfunction in patients with aortocaval fistula.
- To assess the clinical course and outcomes of liver dysfunction associated with aortocaval fistula.
Main Methods:
- Retrospective study of four patients operated on for aortocaval fistula.
- Measurement of serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and creatinine.
- Comparison with four control patients operated on for ruptured abdominal aortic aneurysm (AAA).
Main Results:
- All patients with aortocaval fistula exhibited elevated AST, ALT, and LDH levels.
- Peak liver enzyme and creatinine levels were observed in the early postoperative period.
- Liver function markers normalized with recovery, and all patients survived.
Conclusions:
- Acute ischemic hepatitis is a common complication of aortocaval fistula.
- Liver dysfunction associated with aortocaval fistula has a benign course.
- Successful surgical repair leads to full resolution of liver dysfunction.
Objectives:
To characterise liver dysfunction in patients with aortocaval fistula.
Design:
Retrospective study.
Materials:
All four patients operated on for aortocaval fistula between 1999 and 2003. Three were males with ruptured abdominal aortic aneurysm (AAA). One was a female who underwent lumbar disk surgery. Four patients operated on for ruptured AAA were used as controls.
Methods:
Measurement of serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and creatinine from the preoperative period until full recovery.
Results:
The median delay between the presumed formation of the fistula and surgery was 2 days (range 1-3 days). High levels of AST, ALT and LDH were observed in all patients, starting from the preoperative period, reaching the maximum on the first two postoperative days and normalising thereafter. Median peak values were: AST=4256 IU/l (range 816-7779), ALT=2487 IU/l (range 960-5645) and LDH=15165 IU/l (range 3122-32361). Serum creatinine also sustained alterations with a similar time course. Median peak values were: 256 micromol/l (range 230-468). All the patients survived.
Conclusions:
Acute ischemic hepatitis appears to be a consistent or, at least, a common complication of aortocaval fistula. Although a concern during the perioperative period, its course is benign and fully resolves upon successful surgery.
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