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.

Figure 1

A: Post contrast CT scan reveals a tortuous and aneurysmatic splenic artery of maximum diameter of approximately 52 mm (short white arrow) associated with dilated vessels at the splenic hilum (long white arrow) and early opacification of the portal axis (long black arrow). In addition ascites is present as well (small triangle); B: Celiac angiogram confirms the presence of the splenic artery aneurysm (black arrow) in contiguity with the markedly dilated splenic vein and the premature and intense filling of the splenoportal trunk (black arrowhead and white arrows).

Figure 2

Selective transarterial catheterization (long black arrow) and embolization of the aneurysmal sac with numerous adequate metallic macrocoils (small black arrows) resulted in full occlusion of the sac and the fistulous tract enabling thus the reduction of the pressure in the splenoportal circulation.