Guzman Eduardo A, McCahill Laurence E, Rogers Frederick B
Department of Surgery, University of Vermont, Burlington, USA.
J Gastrointest Surg. 2006 Apr;10(4):543-50. doi: 10.1016/j.gassur.2005.06.022.
Arterioportal fistulas (APFs) are arteriovenous communications between the splanchnic arteries and the portal vein that represent an infrequent cause of presinusoidal portal hypertension. They can be acquired or congenital. Penetrating hepatic trauma, including liver biopsies, represent the most common etiology. They can be asymptomatic or manifest with portal hypertension. An abdominal bruit is a valuable physical finding. Persistence of an APF can cause hepatoportal sclerosis and possibly portal fibrosis. A detailed radiologic evaluation is mandatory. One must differentiate between small peripheral intrahepatic APFs (type 1) and large central APFs (type 2). The former usually resolve spontaneously, whereas the latter can cause portal hypertension and hepatic parenchymal changes. Type 1 APFs caused by needle injury can be followed by Doppler ultrasound. All other fistulas need treatment. Arterioportal fistulas are first treated by transcatheter embolization. Surgical approaches are reserved for complex cases. Congenital APFs (type 3) are diffuse and intrahepatic and can be difficult to manage. Overall, the prognosis is good. Herein, we propose a novel classification for arterioportal fistulas with therapeutic implications.
动门脉瘘（APF）是内脏动脉与门静脉之间的动静脉交通，是窦前性门静脉高压的罕见原因。它们可以是后天获得性的或先天性的。穿透性肝外伤，包括肝活检，是最常见的病因。它们可以无症状，也可表现为门静脉高压。腹部血管杂音是一项有价值的体格检查发现。APF持续存在可导致肝门静脉硬化并可能导致门静脉纤维化。必须进行详细的影像学评估。必须区分小的外周肝内APF（1型）和大的中央APF（2型）。前者通常可自发缓解，而后者可导致门静脉高压和肝实质改变。由针刺损伤引起的1型APF可通过多普勒超声随访。所有其他瘘管均需治疗。动门脉瘘首先通过经导管栓塞治疗。手术方法仅用于复杂病例。先天性APF（3型）是弥漫性肝内瘘，可能难以处理。总体而言，预后良好。在此，我们提出一种具有治疗意义的动门脉瘘新分类法。
