Brief Article
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World J Radiol. Feb 28, 2013; 5(2): 33-40
Published online Feb 28, 2013. doi: 10.4329/wjr.v5.i2.33
Clinical outcomes of symptomatic arterioportal fistulas after transcatheter arterial embolization
Masakazu Hirakawa, Akihiro Nishie, Yoshiki Asayama, Kousei Ishigami, Yasuhiro Ushijima, Nobuhiro Fujita, Hiroshi Honda
Masakazu Hirakawa, Department of Radiology, Kyushu University Beppu Hospital, Oita 874-0838, Japan
Akihiro Nishie, Yoshiki Asayama, Kousei Ishigami, Yasuhiro Ushijima, Nobuhiro Fujita, Hiroshi Honda, Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University Hospital, Fukuoka 812-8582, Japan
Author contributions: Hirakawa M performed the majority of procedures and wrote the manuscript; Nishie A, Asayama Y, Ishigami K, Ushijima Y, Fujita N and Honda H were involved in editing the manuscript.
Correspondence to: Masakazu Hirakawa, MD, PhD, Department of Radiology, Kyushu University Beppu Hospital, 4546 Tsurumihara, Beppu, Oita 874-0838, Japan. mahira@radiol.med.kyushu-u.ac.jp
Telephone: +81-977-271691 Fax: +81-977-273729
Received: October 16, 2012
Revised: December 5, 2012
Accepted: December 15, 2012
Published online: February 28, 2013
Processing time: 150 Days and 8.9 Hours
Abstract

AIM: 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.

CONCLUSION: 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.

Keywords: Arterioportal fistula; Iatrogenic; Portal hypertension; Portal thrombosis; Transcatheter arterial embolization