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11 April 2017 : Case report  USA

Coil Embolization of Spontaneous Splenic Arteriovenous Fistula for Treatment of Portal Hypertension

Unusual setting of medical care, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)

H. Edward Garrett Jr.1ABCDEFG, Lamar Mack1BE

DOI: 10.12659/AJCR.901845

Am J Case Rep 2017; 18:386-390

Abstract

BACKGROUND: Splenic arteriovenous fistula (AVF) is a rare cause of portal hypertension which may manifest with abdominal pain, diarrhea, ascites, and/or hematemesis. Fistula formation may be traumatic or spontaneous. Eighty-six percent of spontaneous splenic AVFs occur in women, and 55% are associated with a preexisting splenic artery aneurysm.

CASE REPORT: A 64-year-old Caucasian female with unremarkable past medical history presented with new onset of left lower quadrant abdominal pain and persistent diarrhea. CTA demonstrated dilated mesenteric veins consistent with portal hypertension. A 1-cm splenic artery aneurysm associated with a splenic AVF was identified and confirmed by celiac angiography. The splenic artery was embolized both distal and proximal to and within the aneurysm sac. Completion arteriography showed minimal flow throughout the splenic artery, and there was no flow into the splenic AVF.

CONCLUSIONS: Traditionally, splenectomy has been the definitive treatment, but coil embolization has been recently reported. Successful coil embolization of a splenic AVF is described. Physicians should be aware of this pathology as an etiology of portal hypertension.

Keywords: Embolization, Therapeutic, Hypertension, Portal, Splenic Artery

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923