title: Hepatic arteriovenous fistulae: role of interventional radiology.
abstract: BACKGROUND
  Hepatic arterial venous fistulae are abnormal communications between the hepatic artery and portal or hepatic vein and commonly occur either secondary to iatrogenic causes like liver biopsy, transhepatic biliary drainage, transhepatic cholangiogram and surgery, or following mechanical insult like blunt or penetrating trauma. Congenital fistulae are rare. Treatment is warranted as an emergency management or in the development of portal hypertension/heart failure in chronic cases. Both surgical and endovascular occlusion of the fistula can be attempted with the latter carrying low intra and post-procedure morbidity. Endovascular treatment has thus currently emerged as a minimally invasive reliable treatment option in such individuals.
  
  
  RESULTS
  We describe a short series consisting of four cases of acquired hepatic arterioportal/venous fistulae, which were referred to interventional radiology for endovascular management over the last 2 years. Three patients had arterio-portal communication and one patient had communication between the hepatic artery and middle hepatic vein. Successful embolization through the transarterial route was achieved in all four patients. A brief discussion of these cases is presented along with a relevant review of literature.
  
  
  CONCLUSIONS
  Endovascular techniques currently form less invasive and first line treatment options in arterioportal/venous fistulae, surgery being reserved only for unsuccessful embolizations/complex fistulae.
authors.affiliation: Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India. ajay2509@gmail.com
authors.forename: Ajay
authors.initials: A
authors.lastname: Kumar
authors.forename: Chirag Kamal
authors.initials: CK
authors.lastname: Ahuja
authors.forename: Sameer
authors.initials: S
authors.lastname: Vyas
authors.forename: Naveen
authors.initials: N
authors.lastname: Kalra
authors.forename: Niranjan
authors.initials: N
authors.lastname: Khandelwal
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Chawla
authors.forename: Radha Krishan
authors.initials: RK
authors.lastname: Dhiman
mesh_terms: D000293:Adolescent; D000328:Adult; D015901:Angiography, Digital Subtraction; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D007049:Iatrogenic Disease; D007223:Infant; D008099:Liver / Q000098:blood supply* / Q000000981:diagnostic imaging; D008297:Male; D011169:Portal Vein / Q000000981:diagnostic imaging*; D015641:Radiography, Interventional; D014057:Tomography, X-Ray Computed; D055815:Young Adult