Saad Wael E A, Davies Mark G, Rubens Deborah J, Sahler Lawrence G, Patel Nikhil C, Lee David E, Kitanosono Takashi, Sasson Talia, Waldman David L
Department of Imaging Sciences, Section of Vascular/Interventional Radiology, University of Rochester Medical Center, Rochester, NY 14642, USA.
Vasc Endovascular Surg. 2006;40(6):451-9. doi: 10.1177/1538574406294072.
Transcatheter embolization of arterioportal fistulae in liver transplant recipients is restricted to symptomatic arterioportal fistulae. Angiograms of liver transplant recipients from a single university medical center were retrospectively reviewed. Hemodynamically significant arterioportal fistulae were defined as those exhibiting opacification of the main portal vein of the transplanted hepatic graft or its first order branch with or without portal venous changes by Doppler ultrasound imaging. Six arterioportal fistulae were found. Doppler ultrasound imaging detected 50% of all arterioportal fistulae and all 3 hemodynamically significant arterioportal fistulae. Three successful embolizations were performed. Follow-up (37 to 67 months) demonstrated patent hepatic arteries and no parenchymal ischemic changes with graft preservation. High-throughput arterioportal fistulae may require larger intrahepatic artery branch embolization. There is a window of opportunity for embolizing significant arterioportal fistulae before their progression to large symptomatic, high through-put arterioportal fistulae with their added risk of ischemic changes before and after embolization.
肝移植受者动脉门静脉瘘的经导管栓塞仅限于有症状的动脉门静脉瘘。对来自单一大学医学中心的肝移植受者的血管造影片进行了回顾性分析。血流动力学显著的动脉门静脉瘘定义为通过多普勒超声成像显示移植肝移植物的主要门静脉或其一级分支出现造影剂充盈，伴或不伴有门静脉改变的情况。共发现6例动脉门静脉瘘。多普勒超声成像检测出了所有动脉门静脉瘘中的50%以及所有3例血流动力学显著的动脉门静脉瘘。进行了3次成功的栓塞治疗。随访（37至67个月）显示肝动脉通畅，未出现实质缺血改变，移植物得以保留。高流量动脉门静脉瘘可能需要更大范围的肝内动脉分支栓塞。在显著的动脉门静脉瘘进展为大型有症状、高流量动脉门静脉瘘并增加栓塞前后缺血改变风险之前，存在栓塞这些瘘的机会窗口。
