PMC3328670_01
Endoscopy showing severe esophagogastric varices (Li, F2, Cw, RC0, Lg-f, F3, Cb, RC2)
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Fig1
Endoscopy showed severe esophagogastric varices (Li, F2, Cw, RC0, Lg-f, F3, Cb, RC2) (Fig. 1).
a Conventional B-mode ultrasonography showing a dilated tubular vascular structure (diameter 17 mm) in the right anterosuperior area; b color Doppler ultrasound of the tubular vascular structure demonstrates an area of color cloud with turbulence; c color Doppler ultrasound showing hepatofugal flow in the portal vein
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Fig2
Triphasic CT scan in the arterial phase shows an enlarged right hepatic artery and pooling of contrast material in the right anterosuperior area of the liver
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Fig3
The pooling image had pronounced enhancement in the arterial phase (Fig. 3).
a Angiography shows an arterioportal fistula between the right hepatic artery and the right portal vein; b angiography shows immediate retrograde filling of the portal vein and reflux to the left gastric vein, as well as extensive collateral circulation through the esophagogastric and perisplenic vascular beds; c complete occlusion of the distal right hepatic artery is seen after emergency coil embolization; d some collateral vessels from the right and left hepatic artery are bypassing the obstructive coils and feeding the area of the fistula
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Fig4
Control hepatic arteriography at the end of the procedure showed complete occlusion of the distal right hepatic artery (Fig. 4c) and hepatopetal flow in the portal vein. Since some collateral vessels from the right and left hepatic arteries bypassed the obstructive coils and still fed the fistulous area (Fig. 4d), transarterial embolization was performed again with 9 fibered platinum microcoils.
Endoscopy showing disappeared esophageal varices and improved gastric varices (Lg-f, F1, Cw, RC0)
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Fig5
F1, Cw, RC0) had improved (Fig. 5). For nearly 6 years postoperatively, this patient has had no further episodes of variceal bleeding.