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Thomas J. Ward, MD, Michael L. Marin, MD, Robert A. Lookstein, MD 

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Presentation on theme: "Thomas J. Ward, MD, Michael L. Marin, MD, Robert A. Lookstein, MD "— Presentation transcript:

1 Embolization of a giant arterioportal fistula requiring multiple Amplatzer vascular plugs 
Thomas J. Ward, MD, Michael L. Marin, MD, Robert A. Lookstein, MD  Journal of Vascular Surgery  Volume 62, Issue 6, Pages (December 2015) DOI: /j.jvs Copyright © 2015 Society for Vascular Surgery Terms and Conditions

2 Fig 1 Reformatted (a and b) and axial (c-e) images of a contrast-enhanced computed tomography scan performed for bruit in a 40-year-old woman. A large arterioportal fistula (APF) from the replaced left hepatic artery (LHA, long arrow) into the left portal vein (LPV, short arrow) is demonstrated. The main portal vein (MPV) (a and b) and LPV were aneurysmal, whereas the right portal vein (RPV) was normal in caliber (e). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

3 Fig 2 Early (a) and later (b) angiogram from the replaced left hepatic artery off the left gastric artery demonstrated a long, large high-flow arterioportal fistula (APF). Angiogram after embolization with four Amplatzer vascular plugs (AVPs) (c) demonstrates APF occlusion and reflux of contrast material. The hepatic arteries to the medial and lateral left hepatic lobe are patent (arrowheads), as is the left gastric artery (arrow). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

4 Fig 3 a, Follow-up computed tomography angiogram performed 2 years after intervention demonstrated occlusion of the fistula, normal hepatic perfusion, and resolution of the portal vein aneurysm. b, The aneurysmal dilation at the origin of the arterioportal fistula (APF) from the left hepatic artery (arrow) also decreased in size from 1.2 to 0.5 cm (x, Amplatzer vascular plug [AVP]). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

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