PMC9489925_01
(A) Enhanced CT shows early portal vein visualization in the arterial phase suggesting hepatic arterioportal fistula (black arrow). (B) Selective hepatic artery angiography demonstrated the dilated right hepatic arteries (black arrow). The left hepatic artery was normal. (C) Endoscopy display the tortuous varices with dilatation and positive RC sign in esophagus. (D) Endoscopy display the tortuous varices with dilatation and positive RC sign in gastric fundus.
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F1
An early enhancement, contrast-enhanced CT showing simultaneous imaging of the artery and the distal right trunk of the portal vein (Figure 1A), indicated a probable arterioportal fistula. Following successful Seldinger technique puncture of the right femoral artery, a 5-F arterial sheath and right hepatic artery catheter were delivered for selective hepatic arteriography, which revealed a significant arterioportal fistula in the right lobe of the liver (Figure 1B). Endoscopic sclerotherapy was performed, and four tortuous varices with dilatation and positive red color (RC) signs were seen throughout the esophagus (Figures 1C,D). The patient recovered well after embolization and sclerotherapy (Figure 2), and no further upper gastrointestinal bleeding and any other complications associated with portal hypertension occurred throughout the 6-months follow-up period (Supplementary Figure S1).
(A) CT scan of the abdomen: CT shows occlusion of the hepatic arterioportal fistula after embolization (black arrow) and reduction of ascites. (B) Selective hepatic artery angiography showing complete closure of the fistula (black arrow) between the right hepatic artery and the right portal vein branch after coil embolization. (C) Improvement of varicose veins after endoscopic sclerotherapy. (D) Improvement of varicose veins after endoscopic sclerotherapy.
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F2
The patient recovered well after embolization and sclerotherapy (Figure 2), and no further upper gastrointestinal bleeding and any other complications associated with portal hypertension occurred throughout the 6-months follow-up period (Supplementary Figure S1).