Hepatic Arterioportal Fistula Following Liver Trauma: Case Series and Review of the Literature.

IF 0.7 4区医学 Q4 PERIPHERAL VASCULAR DISEASE Vascular and Endovascular Surgery Pub Date : 2023-10-01 Epub Date: 2023-03-20 DOI:10.1177/15385744231165155

Soroosh Noorbakhsh, Lissette Gomez, Yoo Joung, Courtney Meyer, Dustin S Hanos, Mari Freedberg, Nathan Klingensmith, April A Grant, Deepika Koganti, Jonathan Nguyen, Randi N Smith, Jason D Sciarretta

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Abstract

Purpose: Hepatic arterioportal fistula (HAPF) is an uncommon complication of hepatic trauma, which can manifest with abdominal pain and the sequelae of portal hypertension months to years after injury. The purpose of this study is to present cases of HAPF from our busy urban trauma center and make recommendations for management.

Methods: One hundred and twenty-seven patients with high-grade penetrating liver injuries (American Association for the Surgery of Trauma [AAST] - Grades IV-V) between January 2019 and October 2022 were retrospectively reviewed. Five patients were identified with an acute hepatic arterioportal fistula following abdominal trauma from our ACS-verified adult Level 1 trauma center. Institutional experience with overall surgical management is described and reviewed with the current literature.

Results: Four of our patients presented in hemorrhagic shock requiring emergent operative intervention. The first patient had postoperative angiography and coil embolization of the HAPF. Patients 2 through 4 underwent damage control laparotomy with temporary abdominal closure followed by postoperative transarterial embolization with gelatin sponge particles (Gelfoam) or combined Gelfoam/n-butyl cyanoacrylate. The final patient went directly for angiography and Gelfoam embolization after identification of the HAPF. All 5 patients had resolution of HAPF on follow-up imaging with continued post management for traumatic injuries.

Conclusion: Hepatic arterioportal fistula can present as a complication of hepatic injury and manifest with significant hemodynamic aberrations. Although surgical intervention was required to achieve hemorrhage control in almost all cases, management of HAPF in the setting of high-grade liver injuries was achieved successfully with modern endovascular techniques. A multidisciplinary approach to such injuries is necessary to optimize care in the acute setting following traumatic injury.

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肝损伤后肝动脉门瘘：病例系列和文献复习。

目的：肝动脉门静脉瘘（HAPF）是肝损伤的一种罕见并发症，可表现为损伤后数月至数年的腹痛和门静脉高压后遗症。本研究的目的是介绍我们繁忙的城市创伤中心的HAPF病例，并提出管理建议。方法：回顾性分析2019年1月至2022年10月期间127例高级穿透性肝损伤（美国创伤外科协会[AAST]-IV-V级）患者。我们的ACS验证的成人1级创伤中心有5名患者在腹部创伤后发现了急性肝动脉门静脉瘘。对整体外科手术管理的机构经验进行了描述，并结合当前文献进行了回顾。结果：4例患者出现失血性休克，需要紧急手术干预。第一例患者行HAPF术后血管造影术和线圈栓塞。2至4名患者接受了损伤控制的剖腹手术，暂时关闭腹部，然后在术后用明胶海绵颗粒（Gelfoam）或Gelfoam/氰基丙烯酸正丁酯联合动脉栓塞。最后一位患者在确认HAPF后直接进行血管造影术和明胶海绵栓塞。所有5名患者在后续影像学检查中均获得了HAPF的分辨率，并在创伤后继续治疗。结论：肝动静脉瘘是肝损伤的一种并发症，表现为明显的血液动力学异常。尽管几乎所有病例都需要手术干预来控制出血，但在高级别肝损伤的情况下，HAPF的管理是通过现代血管内技术成功实现的。有必要对此类损伤采取多学科方法，以优化创伤后急性环境中的护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Vascular and Endovascular Surgery SURGERY-PERIPHERAL VASCULAR DISEASE

CiteScore

1.70

自引率

11.10%

发文量

132

审稿时长

4-8 weeks

期刊介绍： Vascular and Endovascular Surgery (VES) is a peer-reviewed journal that publishes information to guide vascular specialists in endovascular, surgical, and medical treatment of vascular disease. VES contains original scientific articles on vascular intervention, including new endovascular therapies for peripheral artery, aneurysm, carotid, and venous conditions. This journal is a member of the Committee on Publication Ethics (COPE).