Endovascular Management of Splenic Arteriovenous Fistula with Giant Venous Aneurysmal Dilatation

Ibrahim, Wael Hamed; Bassurrah, Hana M

doi:10.3400/avd.cr.12.00009

Cited by 14 publications

(8 citation statements)

References 14 publications

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“…To the best of our knowledge, this is the first report of an aneurysmal formation arising from the venous vasculature of the adrenal gland and the first case of an adrenal vasculature anomaly in a patient with hemophilia A. Moreover, this case represents the largest known aneurysm from all vascular sites reported in the literature [2, 3]. …”

Section: Discussionmentioning

confidence: 95%

“…The overall incidence of VAAs found on autopsy is reported at 0.01–0.2%, with the most common locations being the splenic, hepatic, and celiac arteries [1]. One hundred ninety-nine VVA cases have been published, with the portal venous system accounting for over 95% of these reported occurrences [2, 3]. Our literature search revealed a limited number of aneurysms arising in the adrenal vasculature, with only 11 cases previously reported and all occurring in the adrenal artery [4–14].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Massive adrenal vein aneurysm mimicking an adrenal tumor in a patient with hemophilia A: a case report and review of the literature

Wahlmeier¹,

Carson²,

Drincic³

et al. 2016

J Med Case Reports

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BackgroundVisceral venous aneurysms are exceedingly rare, and until now, there have been no reports of this phenomenon in the adrenal vasculature. This report details the first adrenal venous aneurysm reported in the literature. The aneurysm presented as an 18-cm mass that was initially suspected to be a hematoma or tumor on the basis of the complex medical history of the patient, which included hemophilia A and testicular cancer. After surgical excision, pathologic examination confirmed this mass to be a 15.9-cm adrenal vein aneurysm, the largest aneurysm of any type or location recorded in the medical literature.Case presentationA 58-year-old caucasian male with hemophilia A presented to the emergency room of another institution with abdominal pain, blood in the stool, and a history of diverticulosis and symptomatic hemorrhoids. A large, left-sided adrenal mass was detected by computed tomography, and because of the patient’s hemophilia A and imaging consistent with a hemorrhagic mass, a hematoma was initially suspected. The patient was transferred to our institution, monitored for further bleeding with a stable hospital course, and discharged from the hospital under close monitoring. After 7–8 weeks with no change in the size of the mass, concerns grew regarding increasing symptoms of both satiety and mass effects from the large anomaly, as well as about the patient’s complicated medical history, which also included cancer. Surgical excision was recommended because of the concerns about increasing symptoms and the possibility of a malignancy. Correction and maintenance of factor VIII levels were incorporated pre-, intra-, and postoperatively, and en bloc surgical resection was performed to minimize bleeding and provide oncologic extirpation of the mass. A bowling ball-sized mass was removed, and careful pathologic examination revealed the mass to be a venous adrenal aneurysm. After a brief hospital stay, the patient made a full recovery. Extensive review of the literature revealed 11 reports of adrenal artery aneurysms but no reported case of an adrenal aneurysm arising from the venous system.ConclusionsSeveral case reports suggest a correlation between hemophilia and aneurysms. In patients with inherited clotting disorders such as hemophilia A, aneurysms may present in atypical fashions and should be carefully ruled out.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Massive adrenal vein aneurysm mimicking an adrenal tumor in a patient with hemophilia A: a case report and review of the literature

Wahlmeier¹,

Carson²,

Drincic³

et al. 2016

J Med Case Reports

View full text Add to dashboard Cite

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“…Portal hypertension due to chronic liver disease usually requires a longer period of time. Increased portal pressure is associated with splenomegaly and other gastrointestinal signs [ 5 , 6 ]. This patient had a normally sized spleen and liver.…”

Section: Discussionmentioning

confidence: 99%

The role of computed tomography in detecting splenic arteriovenous fistula and concomitant atrial myxoma

et al. 2014

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Patient: Female, 45Final Diagnosis: Arterio-venous fistula of the spleanSymptoms: Lef-side abdominal painMedication: —Clinical Procedure: —Specialty: SurgeryObjective:Rare diseaseBackground:Splenic arterial-venous fistula and atrial myxoma are not rare cases but the co-existence of both lesions in the same patient is unpublished so far.Case Report:A 45- year-old woman presented with vague left flank pain. She was initially scanned by B-dimensional echography, which revealed multiple enlarged hypo-echoic lesions in the splenic hilum. To further characterize the lesion, we performed computed tomography angiography (CTA). CTA showed dilatation of the splenic artery, and aneurismal dilatation of the splenic vein, associated with early opacification of the portal system. CTA showed also an intrasplenic venous aneurism, which was presumed to be the site of fistulous communication. Celiac arteriography confirmed the CTA findings. A left atrial mass was detected by cardiac echography, which was evaluated better by CTA, and was consistent with atrial myxoma. The patient underwent open surgery in different stage with resection of the atrial mass and spleen. The postoperative period was uneventful.Conclusions:This is a unique case in the literature, showing the coexistence of a dual-pathology splenic arterial venous fistula and atrial myxoma.

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“…Commonly described causes of SAVFs include trauma, inflammatory injury, and idiopathic occurrence [1] . It is thought that spontaneous rupture of a splenic artery into the vein can cause SAVFs, with women of childbearing age and a history of multiparity being most at risk [2 , 3] . In 2017, Garrett et al.…”

Section: Introductionmentioning

confidence: 99%

Endovascular management of incidentally discovered splenic arteriovenous fistula resulting from ruptured splenic aneurysm: Case report and review of the literature

Endovascular Management of Splenic Arteriovenous Fistula with Giant Venous Aneurysmal Dilatation

Cited by 14 publications

References 14 publications

Massive adrenal vein aneurysm mimicking an adrenal tumor in a patient with hemophilia A: a case report and review of the literature

Massive adrenal vein aneurysm mimicking an adrenal tumor in a patient with hemophilia A: a case report and review of the literature

The role of computed tomography in detecting splenic arteriovenous fistula and concomitant atrial myxoma

Endovascular management of incidentally discovered splenic arteriovenous fistula resulting from ruptured splenic aneurysm: Case report and review of the literature

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