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Hepatic arterioportal fistula
A B Lumsden1, R C Allen, S Sreeram
1Department of General Surgery, Emory University Hospital, Atlanta, GA 30322.
The American Surgeon
|November 1, 1993
Summary
Hepatic arterioportal fistula (HAPF) is rare but increasingly diagnosed, often causing gastrointestinal bleeding. Treatment depends on fistula location, with surgery for extrahepatic and embolization for intrahepatic cases.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Hepatology
Background:
- Hepatic arterioportal fistula (HAPF) is an uncommon vascular anomaly.
- Traditionally associated with hepatic artery aneurysm rupture or trauma.
- Increasingly recognized secondary to iatrogenic causes like percutaneous transhepatic procedures.
Observation:
- This study reviews five HAPF cases at Emory University Hospital over five years.
- Etiologies included ruptured hepatic artery aneurysm (2), operative injury (2), and trauma (1).
- Gastrointestinal bleeding due to portal hypertension was the predominant clinical presentation.
Findings:
- Angiography remains the definitive diagnostic tool for HAPF.
- Duplex ultrasonography is emerging as a valuable screening modality.
- Treatment strategies are tailored to fistula location and patient comorbidities.
Implications:
- Even asymptomatic HAPFs require treatment due to portal hypertension risks.
- Surgery is preferred for extrahepatic fistulas; embolization is optimal for intrahepatic ones.
- Embolization offers a vital alternative for patients unsuitable for surgery.