The Arterioportal fistula syndrome : Clinicopathologic features, diagnosis, and therapy

J.-N Vauthey; R. J Tomczak; J Lerut; T Helmberger; P Gertsch; C Forsmark; J Caridi; A Reed; M R Langham; G. Y Lauwers; P Goffette

doi:10.1053/gast.1997.v113.pm9322535

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The Arterioportal fistula syndrome : Clinicopathologic features, diagnosis, and therapy

Journal article

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The Arterioportal fistula syndrome : Clinicopathologic features, diagnosis, and therapy

J.-N Vauthey, R. J Tomczak, J Lerut, T Helmberger, P Gertsch, C Forsmark, J Caridi, A Reed, M R Langham, G. Y Lauwers, …

Gastroenterology (New York, N.Y. 1943), Vol.113(4), pp.1390-1401

1997

DOI: 10.1053/gast.1997.v113.pm9322535

PMID: 9322535

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Abstract

Background and Aims: Arterioportal fistulas (APFs) are rare vascular disorders of the mesenteric circulation. The aim of this study was to determine the etiology, anatomical location, and main symptom at presentation of APFs, and analyze the various modes of treatment. Methods: The etiology, clinical presentation, radiographs, and treatment of 12 patients with APFs are reported in detail, and another 76 cases published since 1980 are reviewed. Results: APFs result from trauma (n = 25, 28%), iatrogenic procedures (n = 14, 16%), congenital vascular malformations (n = 13, 15%), tumor (n = 13, 15%), aneurysm (n = 12, 14%), and other causes (n = 11, 12%). The origin of APFs is the hepatic artery in the majority of patients (n = 56, 65%). The main symptoms at presentation are lower or upper gastrointestinal bleeding (n = 29, 33%), ascites (n = 23.26%), heart failure (n = 4.5%), or diarrhea (n = 4.5%). Radiological intervention provides definitive treatment in 42% (n = 33) of patients, whereas the remainder are treated by surgery alone (n = 27, 31%) or a combination of radiological intervention and surgery (n = 8.9%). Conclusions: APFs result in a protean syndrome variously combining portal hypertension and other hemodynamic imbalances (heart failure, intestinal ischemia). Single or multiple interventional radiological procedures using arterial and/or venous approaches allow definitive treatment of most APFs. With increasing technological advances, it is anticipated that surgery will only be indicated in rare instances after failure of radiological intervention(s).

Biological and medical sciences

Blood and lymphatic vessels

Cardiology. Vascular system

Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous

Medical sciences

Details

Title: Subtitle: The Arterioportal fistula syndrome : Clinicopathologic features, diagnosis, and therapy
Creators: J.-N Vauthey - University of Florida
R. J Tomczak - Department of Radiology, University of Florida College of Medicine, Gainesville, Florida, United States
J Lerut - University of Florida Health
T Helmberger - Department of Radiology, University of Florida College of Medicine, Gainesville, Florida, United States
P Gertsch - Ospedale San Giovanni Bellinzona
C Forsmark - University of Florida Health
J Caridi - University of Florida Health
A Reed - University of Florida Health Science Center
M R Langham - University of Florida Health Science Center
G. Y Lauwers - University of Florida Health
P Goffette - Cliniques Universitaires Saint-Luc
Resource Type: Journal article
Publication Details: Gastroenterology (New York, N.Y. 1943), Vol.113(4), pp.1390-1401
DOI: 10.1053/gast.1997.v113.pm9322535
PMID: 9322535
NLM abbreviation: Gastroenterology
ISSN: 0016-5085
eISSN: 1528-0012
Publisher: Elsevier
Language: English
Date published: 1997
Academic Unit: Accounting; Surgery
Record Identifier: 9984322957902771

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