{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:25:50Z","timestamp":1787315150853,"version":"build-2736575974"},"reference-count":34,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2021,6,14]],"date-time":"2021-06-14T00:00:00Z","timestamp":1623628800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Arterioportal fistulas (APFs) are uncommon vascular abnormalities with a heterogeneous etiology. In pediatric orthotopic liver transplantation (OLT), APFs are frequently iatrogenic, following percutaneous liver interventions. The aim of this study was to report the 10-year experience of a tertiary referral center for pediatric OLT in the interventional radiological (IR) and conservative management of acquired APFs. A retrospective search was performed to retrieve pediatric patients (&lt;18 years old) with a diagnosis of APF at color Doppler ultrasound (CDUS) or computed tomography angiography (CTA) from 2010 to 2020. Criteria for IR treatment were the presence of hemodynamic alterations at CDUS (resistive index &lt;0.5; portal flow reversal) or clinical manifestations (bleeding; portal hypertension). Conservatively managed patients served as a control population. Clinical and imaging follow-up was analyzed. Twenty-three pediatric patients (median age, 4 years; interquartile range = 11 years; 15 males) with 24 APFs were retrieved. Twenty patients were OLT recipients with acquired APFs (16 iatrogenic). Twelve out of twenty-three patients were managed conservatively. The remaining 11 underwent angiography with confirmation of a shunt in 10, who underwent a total of 16 embolization procedures (14 endovascular; 2 transhepatic). Technical success was reached in 12\/16 (75%) procedures. Clinical success was achieved in 8\/11 (73%) patients; three clinical failures resulted in one death and two OLTs. After a median follow-up time of 42 months (range 1\u2013107), successfully treated patients showed an improvement in hemodynamic parameters at CDUS. Conservatively managed patients showed a stable persistence of the shunts in six cases, spontaneous resolution in four, reduction in one and mild shunt increase in one. In pediatric patients undergoing liver interventions, APFs should be investigated. Although asymptomatic in most cases, IR treatment of APFs should be considered whenever hemodynamic changes are found at CDUS.<\/jats:p>","DOI":"10.3390\/jcm10122612","type":"journal-article","created":{"date-parts":[[2021,6,14]],"date-time":"2021-06-14T22:25:46Z","timestamp":1623709546000},"page":"2612","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Arterioportal Fistulas (APFs) in Pediatric Patients: Single Center Experience with Interventional Radiological versus Conservative Management and Clinical Outcomes"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4935-8110","authenticated-orcid":false,"given":"Paolo","family":"Marra","sequence":"first","affiliation":[{"name":"Department of Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"},{"name":"School of Medicine and Post Graduate School of Diagnostic Radiology, University of Milano-Bicocca, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6991-2046","authenticated-orcid":false,"given":"Ludovico","family":"Dulcetta","sequence":"additional","affiliation":[{"name":"Department of Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"},{"name":"School of Medicine and Post Graduate School of Diagnostic Radiology, University of Milano-Bicocca, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco Saverio","family":"Carbone","sequence":"additional","affiliation":[{"name":"Department of Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"},{"name":"School of Medicine and Post Graduate School of Diagnostic Radiology, University of Milano-Bicocca, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Agazzi","sequence":"additional","affiliation":[{"name":"Department of Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Muglia","sequence":"additional","affiliation":[{"name":"Department of Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5335-9429","authenticated-orcid":false,"given":"Pietro Andrea","family":"Bonaffini","sequence":"additional","affiliation":[{"name":"Department of Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"},{"name":"School of Medicine and Post Graduate School of Diagnostic Radiology, University of Milano-Bicocca, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezio","family":"Bonanomi","sequence":"additional","affiliation":[{"name":"Paediatric Intensive Care Unit, Department of Anaesthesia and Intensive Care, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Colledan","sequence":"additional","affiliation":[{"name":"Liver Transplant Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7150-3148","authenticated-orcid":false,"given":"Lorenzo","family":"D\u2019Antiga","sequence":"additional","affiliation":[{"name":"Paediatric Hepatology Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Venturini","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, Circolo Hospital, Insubria University, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandro","family":"Sironi","sequence":"additional","affiliation":[{"name":"Department of Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"},{"name":"School of Medicine and Post Graduate School of Diagnostic Radiology, University of Milano-Bicocca, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1016\/j.gassur.2005.06.022","article-title":"Arterioportal Fistulas: Introduction of a Novel Classification with Therapeutic Implications","volume":"10","author":"Guzman","year":"2006","journal-title":"J. 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