Post-traumatic intrahepatic arteriovenous fistula

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Hepatology

Background:

• Multiple stab wounds to the liver can lead to severe vascular complications.
• Intrahepatic arteriovenous fistulas are rare but serious sequelae of hepatic trauma.
• Associated conditions include portal hypertension, portal thrombus, and chronic cholecystitis.

Observation:

• A large intrahepatic arteriovenous fistula developed post-trauma.
• The fistula caused significant portal hypertension and a non-obstructive portal thrombus.
• Chronic cholecystitis was also observed in the patient.

Findings:

• Catheter embolization via surgical access to the left hepatic artery successfully closed the fistula.
• Initial attempts to occlude arterial flow distant from the fistula failed due to collateral circulation.
• A steel coil placed directly at the fistula site achieved obliteration.
• Postoperative angiography showed resolution of the portal thrombus.

Implications:

• Catheter embolization is an effective treatment for post-traumatic intrahepatic arteriovenous fistulas.
• Angiography and ultrasound B-scanning are crucial for diagnosing hepatic vascular malformations.
• Understanding collateral circulation is vital for successful embolization procedures.