SPECTRUM AND MANAGEMENT OF ABDOMINAL ARTE RIOVENOUS AND ARTERIOPORTALFISTULAS

Purpose: Arterioportal and arteriovenous fistulas (APF, AVF) are rare vascular disorders occurring as a result of congenital vascular malfor mation, trauma, iatrogenic causes or neoplasms. The clinical spectrum of presentation ranges from symptom-free individuals to patients with severe portal hypertension or congestive heart failure. While the majo rity of patients have been treated surgically in the past: interventio nal radiological procedures are being performed with increasing freque ncy. To prove this trend we reviewed the international literature. Rev iew: We reviewed the clinical presentation and management of 79 cases reported between 1980 and 1996 in the literature and six own patients. Results: Review of tile literature and our own six cases show that th ese fistulas can he divided in intrahepatic (n = 49, 75%) and extrahep atic fistulas (n = 20, 25%). The most important causes are trauma (n = 29, 37%), iatrogenic induced by procedures (n = 21, 27%) and congenit al vascular malformations (n = 10; 13%). APFs and AVFs can be diagnose d by ultrasound, computed tomography and magnetic resonance imaging. A ngiography confirms the diagnosis and in many cases allows definitive interventional radiologic treatment. Conclusion: Management of AVFs an d APFs remains a challenge. However interventional radiologic procedur es provide a safe, low-cost, and effective method for treatment. Due t o these facts in the last three years we notice an increasing part of interventional procedures for treatment.