Abstract
Arterioportal fistulas (APFs) are classified into intrahepatic (>75% of all reported)
and extrahepatic (<25% of all reported ). Anecdotally, investigators are more likely
to report more sensational cases (typically extrahepatic APFs), so the actual prevalence
of intrahepatic APFs is probably much higher (likely >90% of APFs). All reported APFs
in liver transplant recipients have been intrahepatic. Hemodynamically significant
APFs in liver transplant recipients are rare, occurring in 0.2%; however, APFs (hemodynamically
significant or not) are not uncommonly seen in hepatic angiograms of liver transplant
recipients (up to 5.4% of hepatic arteriograms in transplants). Interestingly, hemodynamically
significant APFs warranting endovascular treatment are reported more commonly in the
literature in native compared with transplanted livers (n >280–300 versus n = 13, respectively). This article discusses APFs that are specific to liver transplant
recipients; their incidence, etiology, pathogenesis, natural history, clinical presentation,
and endovascular management are discussed in detail.
Keywords transplant - liver - vascular complications - endovascular - portal - arterial - fistula
- embolization
