[Role of transcatheter embolization in intrahepatic arterioportal fistulas]

The treatment outcomes were analysed in 37 patients with intrahepatic arterioportal fistulas (IAPF) of various etiology. In 21 patients with fistulas in the presence of hepatoma, surgical resection (n = 4), hepatic arterial embolization with a hemostatic sponge and metallic spirals (n = 7) and conservative therapy (n = 10) were used. In 4 large iatrogenic IAPF, embolization was conducted just after making a diagnosis; in other 7 cases, a follow-up was accompanied by control arteriography. Embolization was done in all 5 patients with large spontaneous IAPF in the intact and cirrhosis- or hemangioma-related liver. One fatal outcome was observed after embolization in the presence of severe hepatic failure. No other complications were registered. Symptoms of elevated pressures in the portal vein regressed in most patients. It is concluded that despite the cause of occurrence, long-term IAPF results in hyperkinetic portal hypertension, followed by bleeding from the esophageal and gastric varicosity. Arterial embolization of IAPF in the hepatoma reduces the risk for fatal hemorrhage. Small iatrogenic IAPF should be followed up by making control arteriography. Arterial occlusion is the treatment of choice for spontaneous and persistent iatrogenic IAPF. Severe chronic hepatic failure is a contraindication for embolization.