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March 1970

Hepatic Artery-Portal Vein Arteriovenous FistulaReport of a Case With Notes on the Pathophysiology of This Condition

Author Affiliations

Albuquerque, NM
From the Department of Surgery, Veterans Administration Hospital (Dr. Fulton), and Presbyterian Hospital Center (Dr. Wolfel), Albuquerque, NM.

Arch Surg. 1970;100(3):307-309. doi:10.1001/archsurg.1970.01340210083021

Sachs, in 1892, reported for the first time a fistula between the hepatic artery and portal vein. The patient was a child who died of bleeding esophageal varices.1 Sixty years elapsed until this entity was described in a second patient, presenting with ascites and bleeding esophageal varices.2 Subsequently, 16 cases of arteriovenous (AV) fistulae between the hepatic artery and portal vein have been documented.3-18 This is believed to be the 19th report of such an AV fistula. The reasons for reporting the case are threefold: (1) this is a rare condition, (2) there are adverse physiologic effects of these AV fistula other than cardiovascular,1-4,6,7,9,18 and (3) there have been differing opinions concerning the effects of such a fistula upon the heart.11,14

Report of a Case  A 30-year-old white butcher was admitted to the Albuquerque Veterans Administration Hospital for evaluation of an abdominal bruit. The man had

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