A case of diffuse hepatic arteriovenous fistulae with hepatic encephalopathy, postprandial abdominal pain and biliary injury

Akira Kawano, Hirohisa Shigematsu, Toshihiro Maruyama, Hideyuki Nomura, Shinji Shimoda

Research output: Contribution to journalReview article


A 60-year-old woman with hepatic encephalopathy was admitted to our hospital. Ultrasonography, computed tomography and hepatic arteriography revealed diffuse hepatic arteriovenous fistulae (HAVF). Overt portosystemic shunt could not be identified. Right heart catheterization showed increased cardiac output. However the patient had never shown any signs of heart failure. Other than that, marked hepatopetal arterial flow from some branches of the superior mesenteric artery was detected and mesenteric arterial flow remarkably decreased. Extensive HAVF can lead to significant complications, including high output heart failure, pulmonary hypertension, portal hypertension, hepatic encephalopathy, biliary ischemia, cirrhosis, postprandial abdominal pain, and reduced liver function. Embolization or ligation of the hepatic artery provides temporal improvement of clinical symptoms, but long-term results are unsatisfactory because of the development of collateral circulation and the risk of refractory intrahepatic cholangitis, subsequently leading to liver failure. Liver transplantation offers another therapeutic option and can be a successful curative treatment.

Original languageEnglish
Pages (from-to)1039-1048
Number of pages10
JournalJapanese Journal of Gastroenterology
Issue number7
Publication statusPublished - Jul 2009
Externally publishedYes


All Science Journal Classification (ASJC) codes

  • Gastroenterology

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