A clinical case of endovascular treatment of congenital intrahepatic arterioportal fistulae

The development and wide use of instrumental investigational methods, including multispiral computed tomography, computed tomography with angiography, duplex scanning of blood vessels, subtraction angiography, enabled diagnosis of rare diseases, in particular, of the intrahepatic arterioportal fistulae (IAPF). Methods of surgical treatment of this pathology include both open surgery and endovascular treatment with the use of embolizing implants or coils. The article presents a clinical case of diagnosis and endovascular treatment of IAPF in a 33‑year‑old patient, hospitalized in the Center of Interventional Neuroradiology at Feofaniya Clinical Hospital. The choice of the surgical treatment was based on the account of indications and contraindications to the intervention. The endovascular method was used: exclusion of the intrahepatic arterioportal fistulae by means of implantation of micro‑coils Nester 20 мм, MReye 20 mm, Tornado 10–4 mm. Positive dynamics was observed in the long‑term postoperative period (after 3 months), the control was performed based on such criteria as complaints’ absence, normalization of laboratory parameters, positive dynamics of the data of control hepatic angiography. IAPF elimination promoted the reduction of portal hypertension, and improvement of functional liver state. Endovascular method of treatment of patients with arterioportal fistulae is the method of choice at this pathology. The advantages of endovascular method include the minimization of intraoperative and postoperative complications, the shorter postoperative rehabilitation period. In case of the necessity for other method of surgical treatment, one should follow the indications and contraindications to the surgical intervention.

Open Balloon Tamponade and Hepatic Angiography for Hemorrhage Control of Transhepatic Gunshot Wounds in a Hybrid Trauma Operating Room Environment

The management of high-grade liver trauma is challenging and mortality rates are high. Balloon tamponade is a valuable tool for control of transhepatic penetrating injuries. We report three cases of hybrid management of penetrating liver trauma with balloon tamponade and hepatic angiography in a hybrid operating room environment. The combination of balloon tamponade with hepatic angioembolization provides an enhanced approach for the management of these injuries.

Angiographic Findings in Patients with Hepatocellular Carcinoma Previously Treated Using Proton Beam Therapy

Given the growing interest in using proton beam therapy (PBT) for hepatocellular carcinoma (HCC), it is possible that transarterial chemoembolization (TACE) could be used for selected patients who have previously undergone PBT. However, these cases can be technically challenging to treat and require appropriate preparation. Thus, we aimed to identify angiographic findings in this setting. We retrospectively identified 31 patients (28 men and 3 women, mean age: 69 years, range: 43–84 years) who underwent hepatic angiography plus TACE or transarterial infusion chemotherapy (TAI) for HCC that recurred after PBT (July 2007 to June 2018). We discovered four angiographic findings, which we speculate were related to the previous PBT. 18 patients experienced recurrence in the irradiated field, and 13 patients experienced recurrence outside the irradiated field. 29 patients underwent TACE and only 2 patients underwent TAI. The mean number of previous PBT treatments was 1.3 ± 0.6 (range: 1–4). The median interval from the earliest PBT treatment to hepatic angiography was 559 days (range: 34–5,383 days), and the median interval from the latest PBT treatment to hepatic angiography was 464 days (range: 34–5,383 days). Abnormal staining of the irradiated liver parenchyma was observed in 22 patients, which obscured the angiographic tumor staining in 4 patients. Development of a tortuous tumor feeder vessel was observed in 13 patients. Development of an extrahepatic collateral pathway was observed in 7 patients. Development of an arterioportal or arteriovenous shunt was observed in 4 patients. Based on these findings, we conclude that PBT was associated with various angiographic findings during subsequent transarterial chemotherapy for recurrent HCC, and familiarity with these findings will be important in developing appropriate treatment plans.