Division of Interventional Radiology, Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.
Division of Hematology and Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
Cardiovasc Intervent Radiol. 2020 Mar;43(3):466-477. doi: 10.1007/s00270-019-02380-w. Epub 2019 Nov 25.
Arteriovenous malformations (AVMs) are typically congenital in origin, but acquired types, such as dural arteriovenous fistula (AVF), have been described. This study aimed to describe the diagnosis and endovascular treatment of acquired hepatic arterial-portal venous (HA-PV) malformations.
A retrospective review of suspected acquired HA-PV malformations from 9/2011 to 2/2018 was performed. Eight patients (1M:7F, average age 62) with HA-PV malformations were identified. Four (50%) patients had a history of liver transplant. All HA-PV malformations were Yakes type IIIA (multiple inflow arteries with a single vein outflow and with the nidus located within the vein wall). In all cases, computed tomography angiography/magnetic resonance angiography was unable to distinguish AVMs from AVFs, and a wrong diagnosis was made in each instance.
Review of pre-procedural Doppler ultrasounds in all cases demonstrated arterialization of portal vein waveforms. Review of pre-procedural cross-sectional (CT/MR) imaging in all of these cases demonstrates a network of arteries around the portal vein with early portal vein filling in every instance. Attempts to close the shunts via arterial inflow embolization but without venous nidus occlusion were performed and were unsuccessful in five out of eight (62.5%) cases. All curative therapies were via embolization of the outflow vein (segmental or lobar portal vein). Technical success was seen in seven of eight cases (87.5%), while one patient is planned to receive additional nidal vein embolization. Liver function was preserved after treatment without worsening of bilirubin or albumin levels.
The diagnosis of an acquired HA-PV malformation can guide curative endovascular treatment by embolization of the portal vein outflow.
动静脉畸形（AVM）通常为先天性，但也有描述后天性的类型，如硬脑膜动静脉瘘（AVF）。本研究旨在描述获得性肝动脉-门静脉（HA-PV）畸形的诊断和血管内治疗。
回顾性分析 2011 年 9 月至 2018 年 2 月疑似获得性 HA-PV 畸形的病例。共发现 8 例 HA-PV 畸形患者（1 例男性：7 例女性，平均年龄 62 岁）。4 例（50%）患者有肝移植史。所有 HA-PV 畸形均为 Yakes ⅢA型（多支入流动脉，单支静脉流出，病灶位于静脉壁内）。在所有病例中，CT 血管造影/磁共振血管造影均无法将 AVM 与 AVF 区分开来，且每个病例均做出错误诊断。
回顾所有病例的术前多普勒超声检查均显示门静脉波形动脉化。回顾所有这些病例的术前横断面成像（CT/MR）均显示门静脉周围有动脉网络，且门静脉早期充盈。尝试通过动脉入流栓塞来闭塞分流，但未能成功闭塞静脉病灶，这在 8 例中的 5 例（62.5%）中均如此。所有治愈性治疗均通过栓塞静脉流出道（节段性或叶性门静脉）进行。8 例中的 7 例（87.5%）获得技术成功，1 例患者计划接受额外的静脉病灶栓塞。治疗后肝功能得以保留，胆红素和白蛋白水平无恶化。
获得性 HA-PV 畸形的诊断可以指导通过栓塞门静脉流出道进行治愈性血管内治疗。
