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. 2023 Apr 26;6(1):28.
doi: 10.1186/s42155-023-00374-x.

Omental arteriovenous fistula after splenectomy treated with transarterial embolization

Takayuki Sanomura  1 , Takashi Norikane  2 , Satoshi Uchinomura  3 , Yasukage Takami  2 , Toshiya Ensako  3 , Mina Nagao  4 , Akihiro Deguchi  5 , Keiichi Okano  4 , Yoshihiro Nishiyama  2
Affiliations

Omental arteriovenous fistula after splenectomy treated with transarterial embolization

Takayuki Sanomura et al. CVIR Endovasc. .

Abstract

Background: Laparoscopic splenectomy for patients with portal hypertension is associated with a high risk of bleeding. The use of vessel-sealing devices and automatic sutures is important for bleeding control. However, a rare complication of abdominal surgery is the direct communication between the arterial and portal circulation related to surgical procedures such as simultaneous ligature of an artery and adjacent vein. We describe a rare case of omental arteriovenous fistula (AVF) after laparoscopic splenectomy treated with transarterial embolization.

Case presentation: We report a case of a 46-year-old male patient with an omental AVF after a laparoscopic splenectomy 6 years ago for splenomegaly associated with alcoholic cirrhosis. Follow-up abdominal dynamic computed tomography accidentally revealed a vascular sac (25 mm in the major axis) that formed an omental AVF with anastomosis to the left colonic vein. The communication was considered to be caused by using a vessel-sealing device. No symptoms related to the AVF were observed. The AVF was embolized with microcoils using the transarterial approach. A 4-axis catheter system was used for accurate embolization due to the long and tortuous distance from the celiac artery. No recurrence or symptoms were observed after 6 months.

Conclusions: Treatment of arterioportal fistula is mandatory, even in asymptomatic patients. Embolization is a less invasive alternative to surgical approaches. The 4-axis catheter system was useful for accurate embolization via a long and tortuous artery.

Keywords: Embolization; Omental arteriovenous fistula; Vessel-sealing device.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Abdominal contrast-enhanced CT showed an aneurysm-like saccular dilatation in the left upper abdomen (white arrow). A Arterial phase; B VR image
Fig. 2
Fig. 2
Angiography of the celiac artery showed that the dilated omental artery was revealed continuously from the splenic artery (A), turned over, headed toward the vascular sac (B), and returned to the omental vein (white arrow) and left colonic vein (white arrowhead) (C). A stenosis (black arrow) due to ligation at the time of splenectomy was observed in the splenic artery (D)
Fig. 3
Fig. 3
A The 4-axis catheter system (white arrow) was used due to the long and tortuous distance from the celiac artery. B The sac and the end of the feeding artery were embolized with microcoils. C Celiac arteriography after embolization. D Contrast-enhanced CT 6 months after embolization showed complete occlusion
See this image and copyright information in PMC

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