Splenic Arteriovenous Fistula Treated with Percutaneous Transarterial Embolization

Abstract

Splenic arteriovenous fistula is a rare complication following splenectomy. We report a case of a large splenic arteriovenous fistula 23 years after splenectomy in a 50-year old male with abdominal pain, gastro-intestinal bleeding, ascites, diarrhoea, dyspnoea, portal hypertension and heart failure. The arteriovenous fistula was successfully treated with percutaneous transarterial embolization and the patient gained almost complete recovery. This case demonstrates the usefulness of embolization of an otherwise surgical demanding arteriovenous fistula.

Conservative Approach in a 47-Year-Old Male Patient with Incidental Extensive Splenic Arteriovenous Fistula

“…In the literature; excision of the fistula, splenectomy or endovascular interventions are stated as among the treatment options of SAVF [7]. Although the general approach may vary depending on the clinical characteristics of the patient and the experience of the responsible physician and the center, surgical methods are generally associated with higher morbidity and mortality risks compared with minimally invasive methods such as open or laparoscopic when compared with each other.…”

Idiopathic splenic arteriovenous fistula without splenic artery aneurysm

“…Because of the risk of rapid onset of portal hypertension in patients with a SAVF, all detected SAVFs should be excised or embolised, even if the patient is asymptomatic 8. Signs and symptoms of SAVF-related portal hypertension include ascites (35% of patients), oesophageal or gastric varices (52%) and splenomegaly (55%) 2 5 6 9. Variceal bleeding, which occurs in about 45% of patients,6 is the most life-threatening manifestation of a SAVF.…”

The role of computed tomography in detecting splenic arteriovenous fistula and concomitant atrial myxoma

“…The cause can be congenital, infectious, due to pancreatitis, acquired after trauma or accidental penetrating injury, and prior surgery in the abdominal cavity. It is more common in multiparous women than in men, with a sex ratio 4 to 1 [1,2]. SAVFs may stay clinically silent for a long period of time.…”

“…This pathology should be especially suspected in cases when patients complain of a vague left flank pain associated with a loud murmur, or acute portal hypertension not related to chronic liver disease. They may be asymptomatic or lead rapidly to the development of portal hypertension [1,2]. …”