A case of portal hypertension associated with a giant hepatic arterioportal fistula successfully treated with partial hepatic arterial embolization.
Makoto Ueno, Keisuke Ojiro, Yukie Nakadai et al.
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Case in brief
A woman in her 60s presented with massive ascites and was found on imaging to have a giant intrahepatic arterioportal fistula, with multiple communications between the posterior segmental portal vein and arterial inflow from the right hepatic and right inferior phrenic arteries. The fistula was associated with portal hypertension. Because massive ascites made surgery high risk, clinicians performed partial transcatheter embolization of the major hepatic arterial inflow. Although the shunt was not completely occluded, early portal venous enhancement disappeared. Ascites resolved, serum albumin improved, and liver volume increased; she remained recurrence-free for two years.
What made this case unusual
Despite complex communications and incomplete shunt occlusion, embolization targeting arterial inflow was guided by disappearance of early portal venous enhancement, with clinical improvement.
Diagnostic / clinical pearl
In a symptomatic hepatic arterioportal fistula, reduction of arterial inflow may be a procedural goal even when complete shunt occlusion is not achieved; disappearance of early portal venous enhancement was used here as the endpoint.
Why it matters
The case illustrates a less invasive option when massive ascites makes surgery high risk, although optimal treatment strategies for adult-onset symptomatic hepatic arterioportal fistula remain unestablished.