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Frequency of intrahepatic arteriovenous fistula as a sequela to percutaneous needle puncture of the liver.

Incidence of intrahepatic arteriovenous fistula after needle biopsy of the liver, percutaneous transhepatic cholangiography, and transhepatic catheterization of an intrahepatic bile duct or portal vein, was determined by studying the hepatic arteriograms obtained within 1 month of the transhepatic procedure. An arteriovenous fistula, mostly arterioportal, occurred in 5 (5.4%) of the 93 patients after biopsy, in 3 (3.8%) of 79 after percutaneous transhepatic cholangiography, and in 7 (26.2%) of 26 after catheterization. None of the fistulae was so large and close to the porta hepatis as to cause portal hypertension. In 1 patient with an intrahepatic bile duct carcinoma, the long track of a 0.7-mm caliber needle became a fistula draining arterial blood into the parenchyma. In another, an aneurysm was found after biopsy and percutaneous transhepatic cholangiography. The possibility of spontaneous closure of small fistulae is discussed.