Congenital arterioportal fistulas: radiological treatment and color Doppler US follow-up.
BACKGROUND
Congenital intrahepatic arterioportal fistulas (APFs) are a rare cause of portal hypertension in children. Doppler US is a useful diagnostic imaging modality. Transarterial embolization is a minimally invasive and effective therapy allowing occlusion of the fistula and restoration of liver hemodynamics.


OBJECTIVE
To describe the clinical and radiologic findings, percutaneous treatment and role of D-US in the postembolization follow-up of children with APF.


METHODS
Between 2002 and 2011, four children with APF were treated. Initial diagnosis and follow-up was performed with D-US and confirmed by arteriography, followed by endovascular embolization in all patients.


RESULTS
D-US demonstrated abnormal arterioportal communications in all patients. Six endovascular procedures were performed in these four children. In two children, no residual fistula was seen on D-US after the first procedure and symptoms resolved. In the other two children, D-US demonstrated residual flow through the fistula, with resolution of pathological D-US findings and symptoms after the second endovascular procedure. All four children were successfully treated and asymptomatic at the end of follow-up. The mean follow-up was 24 months.


CONCLUSIONS
Interventional radiology has a key role in the treatment of congenital APF. D-US is a noninvasive and effective tool for the diagnosis and follow-up of these patients.
Department of Interventional Radiology, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Pichincha 1890, Buenos Aires, Argentina 1249.
Darío
D
Teplisky
Eliana Urueña
EU
Tincani
José
J
Lipsich
Sergio
S
Sierre
D001164:Arteriovenous Fistula / Q000175:diagnosis* / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D006801:Humans; D006975:Hypertension, Portal; D007223:Infant; D008297:Male; D011169:Portal Vein / Q000002:abnormalities* / Q000000981:diagnostic imaging; D015641:Radiography, Interventional / Q000379:methods*; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color / Q000379:methods*