title: Endoluminal management of arterioportal fistulae in liver transplant recipients: a single-center experience.
abstract: Transcatheter embolization of arterioportal fistulae in liver transplant recipients is restricted to symptomatic arterioportal fistulae. Angiograms of liver transplant recipients from a single university medical center were retrospectively reviewed. Hemodynamically significant arterioportal fistulae were defined as those exhibiting opacification of the main portal vein of the transplanted hepatic graft or its first order branch with or without portal venous changes by Doppler ultrasound imaging. Six arterioportal fistulae were found. Doppler ultrasound imaging detected 50% of all arterioportal fistulae and all 3 hemodynamically significant arterioportal fistulae. Three successful embolizations were performed. Follow-up (37 to 67 months) demonstrated patent hepatic arteries and no parenchymal ischemic changes with graft preservation. High-throughput arterioportal fistulae may require larger intrahepatic artery branch embolization. There is a window of opportunity for embolizing significant arterioportal fistulae before their progression to large symptomatic, high through-put arterioportal fistulae with their added risk of ischemic changes before and after embolization.
authors.affiliation: Department of Imaging Sciences, Section of Vascular/Interventional Radiology, University of Rochester Medical Center, Rochester, NY 14642, USA. wspikes@yahoo.com
authors.forename: Wael E A
authors.initials: WE
authors.lastname: Saad
authors.forename: Mark G
authors.initials: MG
authors.lastname: Davies
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Rubens
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Sahler
authors.forename: Nikhil C
authors.initials: NC
authors.lastname: Patel
authors.forename: David E
authors.initials: DE
authors.lastname: Lee
authors.forename: Takashi
authors.initials: T
authors.lastname: Kitanosono
authors.forename: Talia
authors.initials: T
authors.lastname: Sasson
authors.forename: David L
authors.initials: DL
authors.lastname: Waldman
mesh_terms: D000293:Adolescent; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography; D014481:United States