Splenic arteriovenous fistula and sudden onset of portal hypertension as complications of a ruptured splenic artery aneurysm: Successful treatment with transcatheter arterial embolization. A case study and review of the literature

Abstract

Splenic arteriovenous fistula (SAVF) accounts for an unusual but well-documented treatable cause of portal hypertension([1-4]). A case of a 50-year-old multiparous female who developed suddenly portal hypertension due to SAVF formation is presented. The patient suffered from repeated episodes of haematemesis and melaena during the past twelve days and thus was emergently admitted to hospital for management. Clinical and laboratory investigations established the diagnosis of portal hypertension in the absence of liver parenchymal disease. Endoscopy revealed multiple esophageal bleeding varices. Abdominal computed tomography (CT) and transfemoral celiac arteriography documented the presence of a tortuous and aneurysmatic splenic artery and premature filling of an enlarged splenic vein, findings highly suggestive of an SAVF. The aforementioned vascular abnormality was successfully treated with percutaneous transcatheter embolization. Neither recurrence nor other complications were observed.

Idiopathic splenic arteriovenous fistula without splenic artery aneurysm

“…A SAVF may exist for a substantial period of time without causing symptoms, but the haemodynamic changes that result from the arteriovenous shunt can cause a sudden increase in portal vein pressure 4. On the other hand, portal hypertension due to chronic liver disease develops gradually 7.…”

Gastric variceal bleeding precipitated by a mycotic splenic arteriovenous fistula in a cirrhotic patient: radiological diagnosis and endovascular treatment

“…TIPS has also been proven to be ineffective in the control of variceal bleeding in such patients. (8) SAVF can be treated using transcatheter embolisation or surgery. (9) Embolisation is highly effective and preferred over surgery, due to its lower morbidity and potential for partial splenic preservation.…”

“…(9) Embolisation is highly effective and preferred over surgery, due to its lower morbidity and potential for partial splenic preservation. (4,8,10) Surgery in the form of arterial ligation or splenectomy is usually reserved for patients who have failed transcatheter embolisation. Various materials can be used for embolisation, the choice of which is dependent on the location and flow characteristics of the fistula.…”

Massive upper gastrointestinal bleeding due to giant splenic artery aneurysm with gastric fistula

“…It may be congenital or acquired. Some suspected etiological factors are atherosclerosis, focal arterial inflammation, pancreatitis, hypersplenism, portal hypertension and trauma, hormonal and hemodynamic changes due to pregnancy 1,4,6 . Most patients are asymptomatic and aneurysms are found incidentally on imaging studies.…”