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Arterioportal Fistulas (APFs) in Pediatric Patients: Single Center Experience with Interventional Radiological versus Conservative Management and Clinical Outcomes

Arterioportal fistulas (APFs) are uncommon vascular abnormalities with a heterogeneous etiology. In pediatric orthotopic liver transplantation (OLT), APFs are frequently iatrogenic, following percutaneous liver interventions. The aim of this study was to report the 10-year experience of a tertiary r...

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Autores principales: Marra, Paolo, Dulcetta, Ludovico, Carbone, Francesco Saverio, Agazzi, Roberto, Muglia, Riccardo, Bonaffini, Pietro Andrea, Bonanomi, Ezio, Colledan, Michele, D’Antiga, Lorenzo, Venturini, Massimo, Sironi, Sandro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8231897/
https://www.ncbi.nlm.nih.gov/pubmed/34198478
http://dx.doi.org/10.3390/jcm10122612
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author Marra, Paolo
Dulcetta, Ludovico
Carbone, Francesco Saverio
Agazzi, Roberto
Muglia, Riccardo
Bonaffini, Pietro Andrea
Bonanomi, Ezio
Colledan, Michele
D’Antiga, Lorenzo
Venturini, Massimo
Sironi, Sandro
author_facet Marra, Paolo
Dulcetta, Ludovico
Carbone, Francesco Saverio
Agazzi, Roberto
Muglia, Riccardo
Bonaffini, Pietro Andrea
Bonanomi, Ezio
Colledan, Michele
D’Antiga, Lorenzo
Venturini, Massimo
Sironi, Sandro
author_sort Marra, Paolo
collection PubMed
description Arterioportal fistulas (APFs) are uncommon vascular abnormalities with a heterogeneous etiology. In pediatric orthotopic liver transplantation (OLT), APFs are frequently iatrogenic, following percutaneous liver interventions. The aim of this study was to report the 10-year experience of a tertiary referral center for pediatric OLT in the interventional radiological (IR) and conservative management of acquired APFs. A retrospective search was performed to retrieve pediatric patients (<18 years old) with a diagnosis of APF at color Doppler ultrasound (CDUS) or computed tomography angiography (CTA) from 2010 to 2020. Criteria for IR treatment were the presence of hemodynamic alterations at CDUS (resistive index <0.5; portal flow reversal) or clinical manifestations (bleeding; portal hypertension). Conservatively managed patients served as a control population. Clinical and imaging follow-up was analyzed. Twenty-three pediatric patients (median age, 4 years; interquartile range = 11 years; 15 males) with 24 APFs were retrieved. Twenty patients were OLT recipients with acquired APFs (16 iatrogenic). Twelve out of twenty-three patients were managed conservatively. The remaining 11 underwent angiography with confirmation of a shunt in 10, who underwent a total of 16 embolization procedures (14 endovascular; 2 transhepatic). Technical success was reached in 12/16 (75%) procedures. Clinical success was achieved in 8/11 (73%) patients; three clinical failures resulted in one death and two OLTs. After a median follow-up time of 42 months (range 1–107), successfully treated patients showed an improvement in hemodynamic parameters at CDUS. Conservatively managed patients showed a stable persistence of the shunts in six cases, spontaneous resolution in four, reduction in one and mild shunt increase in one. In pediatric patients undergoing liver interventions, APFs should be investigated. Although asymptomatic in most cases, IR treatment of APFs should be considered whenever hemodynamic changes are found at CDUS.
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spelling pubmed-82318972021-06-26 Arterioportal Fistulas (APFs) in Pediatric Patients: Single Center Experience with Interventional Radiological versus Conservative Management and Clinical Outcomes Marra, Paolo Dulcetta, Ludovico Carbone, Francesco Saverio Agazzi, Roberto Muglia, Riccardo Bonaffini, Pietro Andrea Bonanomi, Ezio Colledan, Michele D’Antiga, Lorenzo Venturini, Massimo Sironi, Sandro J Clin Med Article Arterioportal fistulas (APFs) are uncommon vascular abnormalities with a heterogeneous etiology. In pediatric orthotopic liver transplantation (OLT), APFs are frequently iatrogenic, following percutaneous liver interventions. The aim of this study was to report the 10-year experience of a tertiary referral center for pediatric OLT in the interventional radiological (IR) and conservative management of acquired APFs. A retrospective search was performed to retrieve pediatric patients (<18 years old) with a diagnosis of APF at color Doppler ultrasound (CDUS) or computed tomography angiography (CTA) from 2010 to 2020. Criteria for IR treatment were the presence of hemodynamic alterations at CDUS (resistive index <0.5; portal flow reversal) or clinical manifestations (bleeding; portal hypertension). Conservatively managed patients served as a control population. Clinical and imaging follow-up was analyzed. Twenty-three pediatric patients (median age, 4 years; interquartile range = 11 years; 15 males) with 24 APFs were retrieved. Twenty patients were OLT recipients with acquired APFs (16 iatrogenic). Twelve out of twenty-three patients were managed conservatively. The remaining 11 underwent angiography with confirmation of a shunt in 10, who underwent a total of 16 embolization procedures (14 endovascular; 2 transhepatic). Technical success was reached in 12/16 (75%) procedures. Clinical success was achieved in 8/11 (73%) patients; three clinical failures resulted in one death and two OLTs. After a median follow-up time of 42 months (range 1–107), successfully treated patients showed an improvement in hemodynamic parameters at CDUS. Conservatively managed patients showed a stable persistence of the shunts in six cases, spontaneous resolution in four, reduction in one and mild shunt increase in one. In pediatric patients undergoing liver interventions, APFs should be investigated. Although asymptomatic in most cases, IR treatment of APFs should be considered whenever hemodynamic changes are found at CDUS. MDPI 2021-06-14 /pmc/articles/PMC8231897/ /pubmed/34198478 http://dx.doi.org/10.3390/jcm10122612 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Marra, Paolo
Dulcetta, Ludovico
Carbone, Francesco Saverio
Agazzi, Roberto
Muglia, Riccardo
Bonaffini, Pietro Andrea
Bonanomi, Ezio
Colledan, Michele
D’Antiga, Lorenzo
Venturini, Massimo
Sironi, Sandro
Arterioportal Fistulas (APFs) in Pediatric Patients: Single Center Experience with Interventional Radiological versus Conservative Management and Clinical Outcomes
title Arterioportal Fistulas (APFs) in Pediatric Patients: Single Center Experience with Interventional Radiological versus Conservative Management and Clinical Outcomes
title_full Arterioportal Fistulas (APFs) in Pediatric Patients: Single Center Experience with Interventional Radiological versus Conservative Management and Clinical Outcomes
title_fullStr Arterioportal Fistulas (APFs) in Pediatric Patients: Single Center Experience with Interventional Radiological versus Conservative Management and Clinical Outcomes
title_full_unstemmed Arterioportal Fistulas (APFs) in Pediatric Patients: Single Center Experience with Interventional Radiological versus Conservative Management and Clinical Outcomes
title_short Arterioportal Fistulas (APFs) in Pediatric Patients: Single Center Experience with Interventional Radiological versus Conservative Management and Clinical Outcomes
title_sort arterioportal fistulas (apfs) in pediatric patients: single center experience with interventional radiological versus conservative management and clinical outcomes
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8231897/
https://www.ncbi.nlm.nih.gov/pubmed/34198478
http://dx.doi.org/10.3390/jcm10122612
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