The past three decades resulted in a dynamic development of interventional radiology methods. In the past, most patients with PAF were treated surgically. Nowadays however, interventional radiology procedures are preferred, leaving cases unsuitable for endovascular treatment to classical surgery.
Percutaneous procedures are associated with shorter hospitalization time, reduction of pain, number of complications and perioperative mortality compared to classical surgery.
Literature reports numerous cases of successful endovascular closure of arterioportal fistulas, both congenital and acquired [7
Procedure presented in this publication enabled patient qualification to liver transplantation.
It is worth noting that there are differences between APF embolization procedure in a patient requiring liver transplantation and one with a healthy organ.
Arteriovenous fistulas are often supplied by more than one vessel, which increases the level of difficulty in achieving full APF closure, often requires re-intervention and closure of additional branches supplying the fistula [7
In case of patients referred for heart transplantation, the procedure is not aimed at full closure, but at reducing blood flow through the fistula, so that it is no longer a risk factor for perioperative complications. Interventional radiologist may focus on closing the main supplying vessel and there is no need to obliterate other small-caliber vessels. Fast closure of hepatic artery may be achieved using the Amplatzer®
Vascular Plug (AVP) 4 system, designed for peripheral vessel closure via a diagnostic catheter [11
The procedure is performed quickly, which little exposure to ionizing radiation for the patient and the radiology team. Positioning of the occluder, which is clearly visible in fluoroscopy, seems safe, although it is associated with stretching of the diagnostic catheter used for implantation.
Additional advantage of endovascular fistula closure in a potential liver transplant recipient is related to the fact that his/her own liver will be later resected. It allows for greater leeway in choosing a vessel for embolization. Possible closure of a vessel supplying even a large area of liver parenchyma does not carry the same consequences as for a patient with healthy liver who will need proper native organ function for the rest of his/her life.
Exposure to ionizing radiation is a drawback of percutaneous procedures. Nowadays, there are more and more products on the market such as Amplatzer occluder device, which simplify the procedure and shorten the time of exposure to radiation.
Due to these advantages, endovascular treatment is a relatively simple and quick method of arterioportal fistula occlusion.
Describing this case, we recommend cooperation between transplantology and interventional radiology teams, as it may facilitate liver transplantation.
Literature reports numerous cases of similar cooperation, such as in treatment of transplantological complications using interventional radiology methods [13