Spontaneous hepatic arterioportal fistula in extrahepatic portal vein obstruction: Combined endovascular and surgical management

Ananya Panda; Durgadevi Narayanan; Arjunlokesh Netaji; Vaibhav Kumar Varshney; Lokesh Agarwal; Pawan Kumar Garg

doi:10.14701/ahbps.22-126

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Spontaneous hepatic arterioportal fistula in extrahepatic portal vein obstruction: Combined endovascular and surgical management

Journal article

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Spontaneous hepatic arterioportal fistula in extrahepatic portal vein obstruction: Combined endovascular and surgical management

Ananya Panda, Durgadevi Narayanan, Arjunlokesh Netaji, Vaibhav Kumar Varshney, Lokesh Agarwal and Pawan Kumar Garg

Annals of hepato-biliary-pancreatic surgery, Vol.27(3), pp.307-312

08/01/2023

DOI: 10.14701/ahbps.22-126

PMCID: PMC10472122

PMID: 36944615

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Abstract

Hepatic arterioportal fistulae are abnormal communications between the hepatic artery and portal vein. They are reported to be congenital or acquired secondary to trauma, iatrogenic procedures, hepatic cirrhosis, and hepatocellular carcinoma, but less likely to occur spontaneously. Extrahepatic portal venous obstruction (EHPVO) can lead to pre-hepatic portal hypertension. A spontaneous superimposed hepatic arterioportal fistula can lead to pre-sinusoidal portal hypertension, further exacerbating its physiology. This report describes a young woman with long-standing EHPVO presenting with repeated upper gastrointestinal variceal bleeding and symptomatic hypersplenism. Computed tomography scan demonstrated a cavernous transformation of the portal vein and a macroscopic hepatic arterioportal fistula between the left hepatic artery and portal vein collateral in the central liver. The hepatic arterioportal fistula was associated with a flow-related left hepatic artery aneurysm and a portal venous collateral aneurysm proximal and distal to the fistula, respectively. Endovascular coiling was performed for the hepatic arterioportal fistula, followed by proximal splenorenal shunt procedure. This case illustrates an uncommon association of a spontaneous hepatic arterioportal fistula with EHPVO and the utility of a combined endovascular and surgical approach for managing multifactorial non-cirrhotic portal hypertension in such patients.

Gastroenterology & Hepatology

Life Sciences & Biomedicine

Science & Technology

Surgery

Details

Title: Subtitle: Spontaneous hepatic arterioportal fistula in extrahepatic portal vein obstruction: Combined endovascular and surgical management
Creators: Ananya Panda - All India Institute of Medical Sciences Jodhpur
Durgadevi Narayanan - All India Institute of Medical Sciences Jodhpur
Arjunlokesh Netaji - All India Institute of Medical Sciences Jodhpur
Vaibhav Kumar Varshney - All India Institute of Medical Sciences Jodhpur
Lokesh Agarwal - All India Institute of Medical Sciences Jodhpur
Pawan Kumar Garg - All India Institute of Medical Sciences Jodhpur
Resource Type: Journal article
Publication Details: Annals of hepato-biliary-pancreatic surgery, Vol.27(3), pp.307-312
DOI: 10.14701/ahbps.22-126
PMID: 36944615
PMCID: PMC10472122
NLM abbreviation: Ann Hepatobiliary Pancreat Surg
ISSN: 2508-5778
eISSN: 2508-5859
Publisher: Korean Assoc Hepato-Biliary-Pancreatic Surgery KAHBPS
Number of pages: 6
Language: English
Date published: 08/01/2023
Academic Unit: Radiology
Record Identifier: 9984697720902771

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