{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T11:35:33Z","timestamp":1773920133802,"version":"3.50.1"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T00:00:00Z","timestamp":1751587200000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Florence, Department of Experimental and Clinical Medicine"},{"name":"Italian Ministry of University and Research","award":["PRIN 2022N2KJAM"],"award-info":[{"award-number":["PRIN 2022N2KJAM"]}]},{"name":"Italian Ministry of University and Research","award":["CUP E53D23013280006"],"award-info":[{"award-number":["CUP E53D23013280006"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Transjugular intra-hepatic porto-systemic shunt (TIPS) is a proven strategy for the management of portal hypertension (PH) complications. Here, we report on a complex case of haemorrhagic shock due to the rupture of gastro-oesophageal varices in the context of PH originally sustained by idiopathic, likely congenital, high-flow intrahepatic arterioportal fistulas (IAPFs) preceded by extensive bowel ischaemia. While the occlusion of the IAPFs potentially controlled the steal of arterial splanchnic blood into the portal circulation, it failed to manage PH related bleeding, necessitating the placement of a salvage TIPS. Porta-caval pressure gradient persisted markedly increased after IAPFs occlusion, indicating an independent intra-hepatic component causing PH. Moreover, hepatic histology demonstrated a pre-sinusoidal\/sinusoidal barrage response of the hepatic parenchyma secondary to long-standing IAPFs, causing the onset of an intra-hepatic component of PH. For these reasons, the combined interventional approach led to resolution of the refractory portal hypertensive bleeding, avoiding fatal evolution of diffuse bowel infarction.<\/jats:p>","DOI":"10.1093\/bjrcr\/uaaf034","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T09:20:13Z","timestamp":1751620813000},"source":"Crossref","is-referenced-by-count":1,"title":["Hepatic barrage to high-flow, intra-hepatic arteroportal fistulas requiring combined interventional approach"],"prefix":"10.1093","volume":"11","author":[{"given":"Michele","family":"Citone","sequence":"first","affiliation":[{"name":"Interventional Radiology Unit, Department of Radiology, Careggi University Hospital , Florence, 50134,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonluca","family":"Annese","sequence":"additional","affiliation":[{"name":"Interventional Radiology Unit, Department of Radiology, Careggi University Hospital , Florence, 50134,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giacomo","family":"Gabbani","sequence":"additional","affiliation":[{"name":"Interventional Radiology Unit, Department of Radiology, Careggi University Hospital , Florence, 50134,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Pindozzi","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence , Florence, 50134,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianmarco","family":"Falcone","sequence":"additional","affiliation":[{"name":"Interventional Radiology Unit, Department of Radiology, Careggi University Hospital , Florence, 50134,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuele","family":"Casamassima","sequence":"additional","affiliation":[{"name":"Interventional Radiology Unit, Department of Radiology, Careggi University Hospital , Florence, 50134,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonella","family":"Santolupo","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence , Florence, 50134,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Aspite","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence , Florence, 50134,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Ragozzino","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence , Florence, 50134,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margherita","family":"Falcini","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence , Florence, 50134,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filippo","family":"Biagi","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence , Florence, 50134,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Rosi","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence , Florence, 50134,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina","family":"Adotti","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence , Florence, 50134,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriele","family":"Dragoni","sequence":"additional","affiliation":[{"name":"Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence , Florence, 50134,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davide","family":"Roccarina","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence , Florence, 50134,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2154-0490","authenticated-orcid":false,"given":"Tommaso","family":"Innocenti","sequence":"additional","affiliation":[{"name":"Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence , Florence, 50134,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Messerini","sequence":"additional","affiliation":[{"name":"Pathology Unit, Department of Experimental and Clinical Medicine, University of Florence , Florence, 50134,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Gitto","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence , Florence, 50134,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Mondaini","sequence":"additional","affiliation":[{"name":"Interventional Radiology Unit, Department of Radiology, Careggi University Hospital , Florence, 50134,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Marra","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence , Florence, 50134,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabrizio","family":"Fanelli","sequence":"additional","affiliation":[{"name":"Interventional Radiology Unit, Department of Radiology, Careggi University Hospital , Florence, 50134,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3014-8968","authenticated-orcid":false,"given":"Francesco","family":"Vizzutti","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence , Florence, 50134,","place":["Italy"]},{"name":"Portal Hypertension Departmental Unit, Dipartimento Oncologico e di Chirurgia ad Indirizzo Robotico, Azienda Ospedaliero Universitaria Careggi , Florence, 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