Jornal Vascular Brasileiro
http://www.jvb.periodikos.com.br/article/doi/10.1590/1677-5449.190136
Jornal Vascular Brasileiro
Therapeutic Challenge

Tratamento endovascular da hipertensão portal e da hemorragia digestiva recorrente e secundária à síndrome da fístula arterioportal: complicação tardia de trauma abdominal penetrante

Endovascular treatment of portal hypertension and recurrent digestive hemorrhage secondary to arterioportal fistula syndrome: late complication of penetrating abdominal trauma

Matheus Bertanha; Regina Moura; Rodrigo Gibin Jaldin; Marcone Lima Sobreira; Arthur Curtarelli; Felipe Damacena Rosa; Marcelo Sembenelli; Winston Bonetti Yoshida

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Resumo

Resumo: A síndrome da fístula artério-portal (FAP) é uma rara e reversível causa de hipertensão portal pré-sinusoidal, ocasionada pela comunicação de uma artéria visceral com o sistema venoso portal. A maioria dos pacientes é assintomática, mas quando desenvolvem sintomas, estes são mais relacionados com sangramento gastrointestinal, ascite, insuficiência cardíaca congestiva e diarreia. Este desafio terapêutico apresenta um caso de FAP decorrente de ferimento antigo por arma branca e subsequente evolução clínica desfavorável, com grave desnutrição e frequentes hemorragias digestivas. O caso foi solucionado através de oclusão da FAP por meio de tratamento endovascular.

Palavras-chave

fístula vascular, fístula arteriovenosa, hipertensão portal, ferimentos penetrantes, procedimentos endovasculares

Abstract

The arterioportal fistula (APF) syndrome is a rare and reversible cause of pre-sinusoidal portal hypertension, caused by communication between a visceral artery and the portal venous system. Most patients are asymptomatic, but when they do develop symptoms, these are mainly related to gastrointestinal bleeding, ascites, congestive heart failure, and diarrhea. This therapeutic challenge presents a case of APF caused by a 20-year-old stabbing injury with unfavorable late clinical evolution, including significant malnutrition and severe digestive hemorrhages. The patient was treated using an endovascular procedure to occlude of the fistula.

Keywords

vascular fistula; arteriovenous fistula; portal hypertension; penetrating wounds; endovascular procedures

References

1 Guzman EA, McCahill LE, Rogers FB. Arterioportal fistulas: introduction of a novel classification with therapeutic implications. J Gastrointest Surg. 2006;10(4):543-50. http://dx.doi.org/10.1016/j.gassur.2005.06.022. PMid:16627220.

2 Hernández M, González I, Llop E, et al. Arterioportal fistula, a rare cause of presinusoidal portal hypertension. Gastroenterol Hepatol. 2016;39(1):43-5. http://dx.doi.org/10.1016/j.gastrohep.2015.04.010. PMid:26208886.

3 Hulkower BM, Butty S, Ghabril M. Portal hypertension and ascites due to an arterioportal fistula: sequela of a remote traumatic liver laceration. ACG Case Rep J. 2016;3(4):e121. http://dx.doi.org/10.14309/crj.2016.94. PMid:27807573.

4 Vauthey JN, Tomczak RJ, Helmberger T, et al. The arterioportal fistula syndrome: clinicopathologic features, diagnosis, and therapy. Gastroenterol. 1997;113(4):1390-401. http://dx.doi.org/10.1053/gast.1997.v113.pm9322535. PMid:9322535.

5 Bolognesi M, Sacerdoti D, Bombonato G, Chiesura-Corona M, Merkel C, Gatta A. Arterioportal fistulas in patients with liver cirrhosis: usefulness of color Doppler US for screening. Radiology. 2000;216(3):738-43. http://dx.doi.org/10.1148/radiology.216.3.r00se20738. PMid:10966704.

6 Choi BI, Lee KH, Han JK, Lee JM. Hepatic arterioportal shunts: dynamic CT and MR features. Korean J Radiol. 2002;3(1):1-15. http://dx.doi.org/10.3348/kjr.2002.3.1.1. PMid:11919473.

7 Ward TJ, Marin ML, Lookstein RA. Embolization of a giant arterioportal fistula requiring multiple Amplatzer vascular plugs. J Vasc Surg. 2015;62(6):1636-9. http://dx.doi.org/10.1016/j.jvs.2014.04.031. PMid:24840744.

8 Donovan AJ, Reynolds TB, Mikkelsen WP, Peters RL. Systemic-portal arteriovenous fistulas: Pathological and hemodynamic observations in two patients. Surgery. 1969;66(3):474-82. PMid:5803572.

9 Jabbour N, Reyes J, Zajko A, et al. Arterioportal fistula following liver biopsy: three cases occurring in liver transplant recipients. Dig Dis Sci. 1995;40(5):1041-4. http://dx.doi.org/10.1007/BF02064196. PMid:7729261.

10 Han P, Yang L, Huang X-W, et al. A traumatic hepatic artery pseudoaneurysm and arterioportal fistula, with severe diarrhea as the first symptom: a case report and review of the literature. Medicine. 2018;97(7):e9893. http://dx.doi.org/10.1097/MD.0000000000009893. PMid:29443759.

11 Akpek S, Ilgıt E, Cekirge S, Yücel C. High-flow arterioportal fistula: treatment with detachable balloon occlusion. Abdom Imaging. 2001;26(3):277-80. http://dx.doi.org/10.1007/s002610000174. PMid:11429952.

12 Sonomura T, Kawai N, Kishi K, et al. N-butyl cyanoacrylate embolization with blood flow control of an arterioportal shunt that developed after radiofrequency ablation of hepatocellular carcinoma. Korean J Radiol. 2014;15(2):250-3. http://dx.doi.org/10.3348/kjr.2014.15.2.250. PMid:24643464.

13 Tasar M, Gulec B, Bozlar U, Saglam M, Ugurel MS, Ucoz T. Intrahepatic arterioportal fistula and its treatment with detachable balloon and transcatheter embolization with coils and microspheres. Clin Imaging. 2005;29(5):325-30. http://dx.doi.org/10.1016/j.clinimag.2004.11.023. PMid:16153538.

14 Applbaum YN, Renner JW. Steel coil embolization of hepatoportal fistulae. Cardiovasc Intervent Radiol. 1987;10(2):75-9. http://dx.doi.org/10.1007/BF02577970. PMid:3107829.

15 Nagasue N, Inokuchi K, Kobayashi M, Saku M. Hepatoportal arteriovenous fistula in primary carcinoma of the liver. Surg Gynecol Obstet. 1977;145(4):504-8. PMid:197650.

16 Kaude J, Dudgeon DL, Talbert JL. The role of selective angiography in the diagnosis and treatment of hepatoportal arteriovenous fistula. Radiology. 1969;92(6):1271-2. http://dx.doi.org/10.1148/92.6.1271. PMid:5790635.

17 Lumsden AB, Allen R, Sreeram S, Atta H, Salam A. Hepatic arterioportal fistula. Am Surg. 1993;59(11):722-6. PMid:8239193.

18 Strodel WE, Eckhauser FE, Lemmer JH, Whitehouse WM Jr, Williams DM. Presentation and perioperative management of arterioportal fistulas. Arch Surg. 1987;122(5):563-71. http://dx.doi.org/10.1001/archsurg.1987.01400170069010. PMid:3555408.

19 Basile A, Saluzzo CM, Lupattelli T, et al. Nonoperative management of iatrogenic lesions of celiac branches by using transcatheter arterial embolization. Surg Laparosc Endosc Percutan Tech. 2004;14(5):268-75. http://dx.doi.org/10.1097/00129689-200410000-00008. PMid:15492656.

20 Nookala A, Saberi B, Ter-Oganesyan R, Kanel G, Duong P, Saito T. Isolated arterioportal fistula presenting with variceal hemorrhage. World J Gastroenterol. 2013;19(17):2714-7. http://dx.doi.org/10.3748/wjg.v19.i17.2714. PMid:23674881.
 

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