A case report to be published on April 7, 2009 in the World Journal of Gastroenterology reported incidental findings of a large and solitary congenital APF in a 73-year-old woman. A stubby fistula vessel between left hepatic artery and left portal vein was found in the hepatic artery selective arteriography of the patient by digital subtraction angiography. Three times of transcatheter closure of APF by using multiple coils were performed and they worked. After therapy twice she suffered alimentary tract hemorrhage again. It seems transcatheter closure is not so effective to big APF. The authors considered the reason of therapeutic failure as too much collateral circulation. The purpose of venae coronaria ventriculi and short gastric vein embolised was to cut off the collateral circulation.
Overall, the experience gained from this case suggests the important role of interventional radiology for the management of congenital APF with severe upper gastrointestinal bleeding caused by esophageal and fundus varices. Liver function, abdomen ultrasonography and gastroscopes should perform regularity as fellow-up.