PURPOSE Arteriovenous malformations (AVMs) are typically congenital in origin, but acquired types, such as dural arteriovenous fistula (AVF), have been described. This study aimed to describe the diagnosis and endovascular treatment of acquired hepatic arterial-portal venous (HA-PV) malformations. MATERIALS AND METHODS A retrospective review of suspected acquired HA-PV malformations from 9/2011 to 2/2018 was performed. Eight patients (1M:7F, average age 62) with HA-PV malformations were identified. Four (50%) patients had a history of liver transplant. All HA-PV malformations were Yakes type IIIA (multiple inflow arteries with a single vein outflow and with the nidus located within the vein wall). In all cases, computed tomography angiography/magnetic resonance angiography was unable to distinguish AVMs from AVFs, and a wrong diagnosis was made in each instance. RESULTS Review of pre-procedural Doppler ultrasounds in all cases demonstrated arterialization of portal vein waveforms. Review of pre-procedural cross-sectional (CT/MR) imaging in all of these cases demonstrates a network of arteries around the portal vein with early portal vein filling in every instance. Attempts to close the shunts via arterial inflow embolization but without venous nidus occlusion were performed and were unsuccessful in five out of eight (62.5%) cases. All curative therapies were via embolization of the outflow vein (segmental or lobar portal vein). Technical success was seen in seven of eight cases (87.5%), while one patient is planned to receive additional nidal vein embolization. Liver function was preserved after treatment without worsening of bilirubin or albumin levels. CONCLUSION The diagnosis of an acquired HA-PV malformation can guide curative endovascular treatment by embolization of the portal vein outflow.

中文翻译：

---

获得性肝动脉门静脉畸形的血管内管理​​。

目的动静脉畸形（AVM）通常起源于先天性，但是已经描述了获得性类型，例如硬脑膜动静脉瘘（AVF）。这项研究旨在描述对获得性肝动脉门静脉（HA-PV）畸形的诊断和血管内治疗。材料与方法对9/2011年至2/2018年间疑似获得性HA-PV畸形进行了回顾性研究。确定了8例HA-PV畸形的患者（1M：7F，平均年龄62岁）。四（50％）例患者有肝移植史。所有的HA-PV畸形均为Yakes IIIA型（多发性动脉，单静脉流出，病灶位于静脉壁内）。在所有情况下，计算机断层扫描血管造影/磁共振血管造影无法将AVM与AVF区分开，并且在每种情况下都做出了错误的诊断。结果在所有情况下对术前多普勒超声检查均显示门静脉波形动脉化。在所有这些情况下，对术前横截面（CT / MR）成像的回顾表明，在每种情况下，门静脉周围都有动脉网，早期门静脉充满。尝试通过动脉血流栓塞闭合分流术，但没有静脉阻塞。在八分之八（62.5％）的病例中，均未成功。所有的治疗方法都是通过流出静脉（段或大叶门静脉）的栓塞治疗。8例中有7例（87.5％）取得了技术上的成功，而计划中的1例患者将接受额外的氮化物静脉栓塞术。治疗后肝功能得以保持，而胆红素或白蛋白水平没有恶化。