Abstract
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.
Materials and 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.
Conclusion
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.
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References
Norton SP, Jacobson K, Moroz SP et al (2006) The congenital intrahepatic arterioportal fistula syndrome: elucidation and proposed classification. J Pediatr Gastroenterol Nutr 43:248–255
Vauthey JN, Tomczak RJ, Helmberger T et al (1997) The arterioportal fistula syndrome: clinicopathologic features, diagnosis, and therapy. Gastroenterology 113:1390–1401
Heaton ND, Davenport M, Karani J et al (1995) Congenital hepatoportal arteriovenous fistula. Surgery 117:170–174
Tanaka H, Iwai A, Sugimoto H et al (1991) Intrahepatic arterioportal fistula after blunt hepatic trauma: case reports. J Trauma 31:143–146
Marchand V, Uflacker R, Baker SS et al (1999) Congenital hepatic arterioportal fistula in a 3-year-old child. J Pediatr Gastroenterol Nutr 28:435–441
Routh WD, Keller FS, Cain WS et al (1992) Transcatheter embolization of a high-flow congenital intrahepatic arterial-portal venous malformation in an infant. J Pediatr Surg 27:511–514
Altuntas B, Erden A, Karakurt C et al (1998) Severe portal hypertension due to congenital hepatoportal arteriovenous fistula associated with intrahepatic portal vein aneurysm. J Clin Ultrasound 26:357–360
Burrows PE, Dubois J, Kassarjian A (2001) Pediatric hepatic vascular anomalies. Pediatr Radiol 31:533–545
Gallego C, Miralles M, Marín C et al (2004) Congenital hepatic shunts. Radiographics 24:755–772
Görg C, Riera-Knorrenschild J, Dietrich J (2002) Pictorial review: colour Doppler ultrasound flow patterns in the portal venous system. Br J Radiol 75:919–929
Meunier C, Dabadie A, Darnault P et al (1993) Congenital intrahepatic arterio-portal fistula: diagnostic and therapeutic aspects. Pediatrie 48:211–216
Machado MC, da Cunha JE, Bacchella T et al (1979) Congenital intrahepatic arteriovenous fistula associated with portal hypertension and digestive bleeding. Rev Hosp Clin Fac Med Sao Paulo 34:285–288
Iñon AE, D'Agostino D (1987) Portal hypertension secondary to congenital arterioportal fistula. J Pediatr Gastroenterol Nutr 6:471–473
Bakker J, Robben SG, Hazebroek FW et al (1994) Congenital arterioportal fistula of the liver with reversal of flow in the superior mesenteric vein. Pediatr Radiol 24:198–199
Fellows KE, Hoffer FA, Markowitz RI et al (1991) Multiple collaterals to hepatic infantile hemangioendotheliomas and arteriovenous malformations: effect on embolization. Radiology 181:813–818
Gryboski JD, Clemett A (1967) Congenital hepatic artery aneurysm with superior mesenteric artery insufficiency: a steal syndrome. Pediatrics 39:344–347
Raghuram L, Korah IP, Jaya V et al (2001) Coil embolization of a solitary congenital intrahepatic hepatoportal fistula. Abdom Imaging 26:194–196
Lamireau T, Chateil JF, Petit P et al (1999) Successful embolization of congenital intrahepatic arterioportal fistula in two infants. J Pediatr Gastroenterol Nutr 29:211–214
Kumar N, de Goyet JV, Sharif K et al (2003) Congenital, solitary, large, intrahepatic arterioportal fistula in a child: management and review of the literature. Pediatr Radiol 33:20–23
Bilbao JI, Martínez-Cuesta A, Urtasun F et al (2006) Complications of embolization. Semin Interv Radiol 23:126–142
Stell D, Downey D, Marotta P et al (2004) Prospective evaluation of the role of quantitative Doppler ultrasound surveillance in liver transplantation. Liver Transpl 10:1183–1188
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Teplisky, D., Tincani, E.U., Lipsich, J. et al. Congenital arterioportal fistulas: radiological treatment and color Doppler US follow-up. Pediatr Radiol 42, 1326–1332 (2012). https://doi.org/10.1007/s00247-012-2443-x
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DOI: https://doi.org/10.1007/s00247-012-2443-x