Intraabdominal arterio-venous fistulae and their relation to portal hypertension.
OBJECTIVE
The aim of the study was to present, on the base of own experience, clinical importance of arterio-venous fistulae involving the vascular system of the abdomen.


METHODS
Clinical material consists of 18 patients in whom abnormal arterio-venous leakage in the abdomen was disclosed by means of imaging diagnostic techniques and Doppler sonographic hemodynamic investigations. Three groups of patients were determined: 1. Patients in whom arterio-venous fistula was a primary cause of portal hypertension (N = 6), 2. Patients in whom the presence of arterio-venous fistulae aggravated portal hypertension due to other pathology (N = 7). 3. Patients in whom the arterio-venous fistulae did not directly affect portal flow (N = 5). As each case presented a different clinical problem, the therapeutic approach had to be individualized. In 12 patients perarterial embolization was performed, 13 patients were operated on, one patient was listed for liver transplantation.


RESULTS
Perarterial embolization was fully effective only in 4 cases. In the remaining 8 cases its effect was transient, but in 4 cases of liver tumors it allowed us to proceed with chemoembolization and the others were subsequently treated surgically. In 12 surgically treated patients the operation proved to be curative. In 1 case of multiple arterio-venous fistulae related to diffuse angiomatosis, surgical procedure was unfeasible. One patient, awaiting liver transplantation, died of liver failure.


CONCLUSIONS
1. Arterio-venous fistulae (of various etiology) are rarely found in the abdominal cavity, but their presence means usually serious consequences depending on their morphology and localization. 2. Arterio-venous fistulae involving the portal system may result in severe portal hypertension. 3. Individually chosen method of treatment, aimed at the occlusion of arterio-venous fistula often proves to be curative. 4. Overlooking or ignoring the presence of intraabdominal arterio-venous fistulae leads to unsuccessful, if not harmful treatment.
Michalowicz
Bogdan
B
Department of General and Liver Surgery, Medical University of Warsaw-ul. Banacha 1a, 02 097 Warszawa, Poland. bmichalowicz@qdnet.pl
Pawlak
Jacek
J
Malkowski
Piotr
P
Zieniewicz
Krzysztof
K
Nyckowsk
Pawel
P
Leowska
Elzbieta
E
Rowinski
Olgierd
O
Pacho
Ryszard
R
Krawczyk
Marek
M
D000005:Abdomen / Q000098:blood supply*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008099:Liver / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011168:Portal System; D012307:Risk Factors; D018608:Ultrasonography, Doppler