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Arterioportal fistulas: twelve cases
Annals of Vascular Surgery
|November 1, 1990
Summary
Arterioportal fistulas, often acquired and iatrogenic, can cause severe bleeding or ischemia. Surgical or embolization treatments are effective, with recurrence linked to cirrhosis or congenital causes.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Arterioportal fistulas (APFs) are abnormal connections between arteries and portal veins.
- They can lead to significant gastrointestinal bleeding or mesenteric ischemia.
Purpose of the Study:
- To review the experience with arterioportal fistulas over 20 years.
- To analyze the causes, presentations, treatments, and outcomes of APFs.
Main Methods:
- Retrospective review of 14 APFs in 12 patients over 20 years.
- Analysis of fistula origin, etiology (congenital vs. acquired, iatrogenic), clinical presentation, and treatment modality (surgical vs. embolization).
Main Results:
- 14 APFs identified in 12 patients; 10 acquired (7 iatrogenic).
- Common presentations: gastrointestinal hemorrhage and mesenteric artery insufficiency.
- Treatments included surgery (8) and arterial embolization (5); no early mortality.
- Hemorrhagic and ischemic complications resolved post-treatment.
- Three recurrences noted in patients with cirrhosis or congenital AV fistula.
Conclusions:
- Symptomatic APF closure is clinically justified.
- Treatment choice requires individualized discussion between surgeons and interventional radiologists.