B. Michałowicz, J. Pawlak, P. Małkowski, K. Zieniewicz, P. Nyckowski, E. Leowska, O. Rowiński, R. Pacho, M. Krawczyk
Med Sci Monit 2003; 9(2): 52-55
Available online: 2003-05-20
Background: The authors present their own material of patients treated in the period 1089-2002 in whom arterio- venous fistulae (AVF)involving the vascular system of the abdominal cavity were diagnosed. Material/Methods: Clinical material consists of 21 patients treated for portal hypertension, liver tumors an intestinal bleednigs, in whom abnormal a-v leakage in the abdomen was disclosed by means of imaging diagnostic techniques and Doppler sonographic haemodynamic investigations.As each case presented a different clinical problem,the therapeutic approach had to be individualized.In 12 patients perarterial embolization was performed,13 patients were operated on,one patient was listed for liver transplantation. Results: In 13 surgivally treated patients the operation showed to be curative.In 1 case of multiple AVF related to diffuse angiomatosis,surgical procedure was unfeasible. Perarterial embolization was fully effective only in 4 cases.In the remaining 10 cases it ’s effect was transient,but in 6 cases of liver tumors it allowed to proceed with chemoembolization and the others were subsequently treated surgically.One patient,awaiting liver transplantation,died of liver failure. Conclusions: 1.Arterio-venous fistulae (of various etiology)are rarely found in the abdominal cavity, but their presence means usually serious consequences depending on their morphology and localization. 2.A-v fistulae involving the portal system may result in severe portal hypertension. 3.Individually chosen method of treatment,aimed at the oclusion of AVF often shows to be curative. 4.Overlooking or ignoring the presence of intraabdominal a-v fistulae leads to unseccessful,if not harmful treatment.
Keywords: arterio-venous fistula, ortal hypertension, esophageal varices, variceal bleeding, interventional radiology, perarterial embolization