Post-operative splenic arteriovenous fistula detected with 16-multidetector computed tomography

Abstract

We herein report on a new radiological case of post-operative splenic arteriovenous fistulae (SAVF) with CT-based diagnosis. A brief review of the inherent literature is also discussed.

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

“…Typical Doppler findings include the following: (a) pulsatile, high-flow velocity within the fistula; (b) fairly pulsatile, high-velocity venous flow immediately distal to the fistula, sometimes extending into the splenic and portal veins; (c) increased afferent splenic arterial diameter and flow velocity; and (d) enlarged diameter and flow velocity in the splenic and portal veins. (6) SAVF can be confirmed on CT angiography in the presence of dense opacification of the splenic vein in the arterial phase, along with varices and dilatation of the splenic vein. (7) Nevertheless, catheter angiography is the gold standard for the detection of SAVF, and diagnosis is confirmed in the presence of early, rapid opacification of the splenic and portal veins, along with dilatation of the splenic artery and vein.…”

Laparoscopic Splenectomy in Children: A Modified Technique with Joint Sealing of Segmental Splenic Arteries and Veins Favorably Compared with the Classic Technique

“…18 Postsplenectomy splenic arteriovenous fistula represented 15% of all splenic arteriovenous fistula etiologies 19 and were most commonly associated with a large caliber of forming vessels. 11 Complications of splenic arteriovenous fistula included splenic artery pseudoaneurysm and portal hypertension; in the former the aneurysm rupture rate was 3 to 10%, with a mortality rate after rupture of 10 to 25%. 20 However, splenic arteriovenous fistula remained an extremely rare complication 4,7,17 .…”

“…9 Whatever the technical device used, there has been a long-standing perception that "en bloc" ligation of the main artery and vein might increase the risk of splenic arteriovenous fistula, a rare but significant postoperative complication. [10][11][12] On the contrary, sealing the secondary splenic pedicles has been described in adults without additional morbidities. 13 We hereby describe a modified pediatric LS technique with vascular control of segmental pedicles and compare its perioperative and long-term results with the classic surgical technique.…”

Idiopathic splenic arteriovenous fistula without splenic artery aneurysm

“…Until recently, the standard technique for detecting a SAVF was coeliac or splenic arteriography. Now, however, ultrasonography or CT scanning can be used to establish the diagnosis 1 3–5 12. When a bruit is heard over the left flank, colour Doppler ultrasonography should first be performed to characterise the direction and velocity of blood flow.…”

“…Congenital SAVFs occur most frequently in patients with Ehlers-Danlos or Rendu-Osler-Weber syndrome 1. Acquired SAVFs are commonly due to blunt trauma, surgery or a penetrating injury that results in direct arteriovenous communication.…”