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