Splenic Arteriovenous Fistula with Pseudoaneurysm

A 24-year-old male patient with a history of laparoscopic splenectomy presented to the outpatient clinic with pain and fullness in the left upper quadrant of the abdomen. Physical examination and laboratory results were unremarkable. Contrast-enhanced computed tomography (CT) showed aneurysm with a maximum diameter of 30 mm on the distal part of the tortuous splenic artery and splenic arteriovenous fistula and early opacification of the splenic vein ( [Fig. 1A], [B] ). Three-dimensional CT reconstruction revealed aneurysm and connection between the splenic artery and vein ( [Fig. 1C] ). Aneurysm was interpreted in favor of pseudoaneurysm in the case with a splenectomy history. Splenic artery pseudoaneurysm with splenic arteriovenous fistula infrequently occurs as a complication of splenectomy. Rupture and portal hypertension are potential complications. This patient subsequently underwent endovascular intervention, treated with coil embolization, and has continued to do well on clinical follow-up visits.

Fig. 1 (A–C) Contrast-enhanced computed tomography (CT) showed aneurysm with a maximum diameter of 30 mm on the distal part of the tortuous splenic artery and splenic arteriovenous fistula and early opacification of the splenic vein. (C) Three-dimensional CT reconstruction revealed aneurysm and connection between the splenic artery and vein. A, anterior; Av, average; F, front; L, left; P, posterior; R, right; SD, standard deviation.

Discussion

Occurrence of a splenic artery pseudoaneurysm with an arteriovenous fistula is a rare complication might be seen after splenectomy.[1] Rupture is the major risk of splenic artery pseudoaneurysm and mortality is almost inevitable if it rupture.[2] Also, untreated splenic arteriovenous fistulas may cause portal hypertension.[1] Therefore, splenic pseudoaneurysm must be treated without delay regardless of their size, even if there is no bleeding due to high-rupture risk.[2] [3] Contrast-enhanced CT, CT angiography, and splenic arteriogram are valuable for diagnosis. Conventionally, splenic pseudoaneurysm was managed by surgery, but endovascular approach became the mainstay treatment in recent years.[2] [3] As a conclusion, diagnosis and treatment of splenic pseudoaneurysm and arteriovenous fistula are crucial to avoid associated fatal risks.

Conflict of Interest

None declared.

• References

• 1 Gartside R, Gamelli RL. Splenic arteriovenous fistula. J Trauma 1987; 27 (06) 671-673
• 2 McDermott VG, Shlansky-Goldberg R, Cope C. Endovascular management of splenic artery aneurysms and pseudoaneurysms. Cardiovasc Intervent Radiol 1994; 17 (04) 179-184
• 3 Guillon R, Garcier JM, Abergel A. et al Management of splenic artery aneurysms and false aneurysms with endovascular treatment in 12 patients. Cardiovasc Intervent Radiol 2003; 26 (03) 256-260

Publication History

Article published online:
17 April 2021