肝移植受者的动脉门静脉瘘
Arterioportal fistulas in liver transplant recipients.
作者信息
Saad Wael E A
机构信息
Division of Vascular Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia.
出版信息
Semin Intervent Radiol. 2012 Jun;29(2):105-10. doi: 10.1055/s-0032-1312571.
Arterioportal fistulas (APFs) are classified into intrahepatic (>75% of all reported) and extrahepatic (<25% of all reported ). Anecdotally, investigators are more likely to report more sensational cases (typically extrahepatic APFs), so the actual prevalence of intrahepatic APFs is probably much higher (likely >90% of APFs). All reported APFs in liver transplant recipients have been intrahepatic. Hemodynamically significant APFs in liver transplant recipients are rare, occurring in 0.2%; however, APFs (hemodynamically significant or not) are not uncommonly seen in hepatic angiograms of liver transplant recipients (up to 5.4% of hepatic arteriograms in transplants). Interestingly, hemodynamically significant APFs warranting endovascular treatment are reported more commonly in the literature in native compared with transplanted livers (n >280-300 versus n = 13, respectively). This article discusses APFs that are specific to liver transplant recipients; their incidence, etiology, pathogenesis, natural history, clinical presentation, and endovascular management are discussed in detail.
动门脉瘘（APF）分为肝内型（占所有报道病例的75%以上）和肝外型（占所有报道病例的25%以下）。据传闻，研究人员更倾向于报告更耸人听闻的病例（通常是肝外型APF），因此肝内型APF的实际患病率可能要高得多（可能占所有APF的90%以上）。肝移植受者中所有报道的APF均为肝内型。肝移植受者中具有血流动力学意义的APF很少见，发生率为0.2%；然而，在肝移植受者的肝血管造影中，APF（无论有无血流动力学意义）并不罕见（在移植肝动脉造影中高达5.4%）。有趣的是，与移植肝相比，文献中报道的需要进行血管内治疗的具有血流动力学意义的APF在天然肝脏中更为常见（分别为n>280 - 300和n = 13）。本文讨论肝移植受者特有的APF；详细讨论了它们的发病率、病因、发病机制、自然史、临床表现和血管内治疗。
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