title: Clinical outcomes of symptomatic arterioportal fistulas after transcatheter arterial embolization.
abstract: OBJECTIVE
  To evaluate the complications and clinical outcomes of transcatheter arterial embolization (TAE) for symptoms related to severe arterioportal fistulas (APFs).
  
  
  METHODS
  Six patients (3 males, 3 females; mean age, 63.8 years; age range, 60-71 years) with chronic liver disease and severe APFs due to percutaneous intrahepatic treatment (n = 5) and portal vein (PV) tumor thrombosis of hepatocellular carcinoma (n = 1) underwent TAE for symptoms related to severe APFs [refractory ascites (n = 4), hemorrhoidal hemorrhage (n = 1), and hepatic encephalopathy (n = 1)]. Control of symptoms related to APFs and complications were evaluated during the follow-up period (range, 4-57 mo).
  
  
  RESULTS
  In all patients, celiac angiography revealed immediate retrograde visualization of the main PV before TAE, indicating severe APF. Selective TAE for the hepatic arteries was performed using metallic coils (MC, n = 4) and both MCs and n-butyl cyanoacrylate (n = 2). Three patients underwent repeated TAEs for residual APFs and ascites. Four patients developed PV thrombosis after TAE. During the follow-up period after TAE, APF obliteration and symptomatic improvement were obtained in all patients.
  
  
  CONCLUSIONS
  Although TAE for severe APFs may sometimes be complicated by PV thrombosis, TAE can be an effective treatment to improve clinical symptoms related to severe APFs.
authors.affiliation: Masakazu Hirakawa, Department of Radiology, Kyushu University Beppu Hospital, Oita 874-0838, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Hirakawa
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nishie
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Asayama
authors.forename: Kousei
authors.initials: K
authors.lastname: Ishigami
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ushijima
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Fujita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Honda
keywords: Arterioportal fistula; Iatrogenic; Portal hypertension; Portal thrombosis; Transcatheter arterial embolization