Embolization of an Arterioportal Fistula by Injection of D-Stat into the Portal Venous Outflow

Arterioportal fistulas may occur in liver transplant recipients after percutaneous biopsy. This report describes a case in which a 13-year-old liver transplant patient developed an arterioportal fistula after multiple liver biopsies and underwent coil embolization; however, at that time, there were at least two small arterial feeders that were not amenable to subselection. He later developed recurrent variceal bleeding, and repeat angiogram revealed multiple tiny serpentine feeding arteries. Because these arteries could not be subselectively catheterized, the collagen-thrombin mixture, D-Stat, was used to occlude the portal venous outflow of the arterioportal fistula. Subsequent angiography demonstrated successful complete occlusion of the arterioportal fistula.