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Negmadjanov U, Vazquez OA, Ross RL, Hamm AD, Buicko JL, Lopez-Viego MA. Portal Hypertension Due to a Traumatic Arteriovenous Fistula in a Patient With a Celiac Artery Aneurysm. Am Surg 2023; 89:6200-6202. [PMID: 35850555 DOI: 10.1177/00031348221111518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article describes a rare case of a traumatic splenic arteriovenous fistula (AVF) causing portal hypertension in a patient presenting with abdominal pain, diarrhea, and melena. A 78-year-old was admitted to the hospital with abdominal pain. The patient's history was notable for prior laparotomy and left nephrectomy for a gunshot wound. Workup demonstrated portal hypertension with a dilated splenic vein with aneurysmal changes and a saccular celiac artery aneurysm. Celiac angiogram demonstrated a communication between celiac and portal circulation. The patient underwent laparotomy with ligation of the splenic artery and resection of the celiac artery aneurysm. In conclusion, splenic AVFs are relatively rare in clinical practice. Once the diagnosis is established, operative intervention is required to avoid complications of portal hypertension. Surgical ligation has been used in this case with a successful outcome.
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Affiliation(s)
- Ulugbek Negmadjanov
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Oscar A Vazquez
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Reagan L Ross
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Aidan D Hamm
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Jessica L Buicko
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Miguel A Lopez-Viego
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
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Alexander E, Santos E. Endovascular management of incidentally discovered splenic arteriovenous fistula resulting from ruptured splenic aneurysm: Case report and review of the literature. Radiol Case Rep 2023; 18:2465-2469. [PMID: 37235078 PMCID: PMC10206381 DOI: 10.1016/j.radcr.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 05/28/2023] Open
Abstract
Splenic arteriovenous fistulas (SAVFs) are rare vascular anomalies, which have a described association with splenic artery aneurysms. Treatment options include surgical fistula excision, splenectomy, or percutaneous embolization. Here we present a unique case of endovascular repair of a splenic arteriovenous fistula (SAVFs) associated with a splenic aneurysm. A patient with past medical history of early-stage invasive lobular carcinoma was referred to our interventional radiology practice to discuss an incidentally discovered splenic "vascular malformation" discovered during magnetic resonance imaging of the abdomen and pelvis. Arteriography demonstrated smooth dilatation of the splenic artery, with a fusiform aneurysm which had fistulized to the splenic vein. There were high flows and early filling of the portal venous system. The splenic artery, immediately proximal to the aneurysm sac, was catheterized using a microsystem and embolized using coils and N-butyl cyanoacrylate. Complete occlusion of the aneurysm and resolution of the fistulous connection was achieved. The patient was discharged home the following day, without complication. Associated splenic artery aneurysms and SAVFs are rare occurrences. Timely management is necessary to prevent adverse sequelae such as aneurysm rupture, further enlargement of the aneurysmal sac, or portal hypertension. Endovascular treatment, including n-Butyl Cyanoacrylate glue and coils, offers a minimally invasive treatment option, with facile recovery and low morbidity.
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Zhu Y, Xiong J, Liu F, Guo W. Splenic Arteriovenous Fistula Accompanied by Splenic Artery Aneurysm Associated with Acute-onset Portal Hypertension and Gastrointestinal Bleeding: Case Report and Literature Review. Ann Vasc Surg 2021; 78:378.e17-378.e22. [PMID: 34487808 DOI: 10.1016/j.avsg.2021.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 06/15/2021] [Accepted: 06/20/2021] [Indexed: 11/01/2022]
Abstract
Splenic arteriovenous fistula is an uncommon aetiology of portal hypertension, which has definitive treatment effectiveness and good prognosis. We report a case of portal hypertension and gastrointestinal bleeding in the absence of hepatic parenchymal disease in a 50 year-old woman with multiple pregnancies. Abdominal computed tomography and transabdominal arteriography recorded the presence of tortuous and aneurysmal splenic arteries and the premature filling of enlarged splenic veins, which are highly suggestive of splenic arteriovenous fistula. The above vascular abnormalities were successfully treated by transcatheter embolization. No recurrence or other complications were observed. In addition, a literature review concerning splenic arteriovenous fistula published in recent 30 years was performed to further our understanding of the management strategy on this entity.
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Affiliation(s)
- Yating Zhu
- Department of Vascular and Endovascular Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Feng Liu
- Department of Vascular and Endovascular Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wei Guo
- Department of Vascular and Endovascular Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China.
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Djordjevic I, Zivanovic D, Budic I, Kostic A, Djeric D. Importance of a Follow-Up Ultrasound Protocol in Monitoring Posttraumatic Spleen Complications in Children Treated with a Non-Operative Management. MEDICINA-LITHUANIA 2021; 57:medicina57080734. [PMID: 34440940 PMCID: PMC8400664 DOI: 10.3390/medicina57080734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/16/2021] [Accepted: 07/18/2021] [Indexed: 01/10/2023]
Abstract
Background and objectives: For the last three decades, non-operative management (NOM) has been the standard in the treatment of clinically stable patients with blunt spleen injury, with a success rate of up to 95%. However, there are no prospective issues in the literature dealing with the incidence and type of splenic complications after NOM. Materials and methods: This study analyzed 76 pediatric patients, up to the age of 18, with blunt splenic injury who were treated non-operatively. All patients were included in a posttraumatic follow-up protocol with ultrasound examinations 4 and 12 weeks after injury. Results: The mean age of the children was 9.58 ± 3.97 years (range 1.98 to 17.75 years), with no statistically significant difference between the genders. The severity of the injury was determined according to the American Association for Surgery of Trauma (AAST) classification: 7 patients had grade I injuries (89.21%), 21 patients had grade II injuries (27.63%), 33 patients had grade III injuries (43.42%), and 15 patients had grade IV injuries (19.73%). The majority of the injuries were so-called high-energy ones, which were recorded in 45 patients (59.21%). According to a previously created posttraumatic follow-up protocol, complications were detected in 16 patients (21.05%). Hematomas had the highest incidence and were detected in 11 patients (14.47%), while pseudocysts were detected in 3 (3.94%), and a splenic abscess and pseudoaneurysm were detected in 1 patient (1.31%), respectively. The complications were in a direct correlation with injury grade: seven occurred in patients with grade IV injuries (9.21%), five occurred in children with grade III injuries (6.57%), three occurred in patients with grade II injuries (3.94%), and one occurred in a patient with a grade I injury (1.31%). Conclusion: Based on the severity of the spleen injury, it is difficult to predict the further course of developing complications, but complications are more common in high-grade injuries. The implementation of a follow-up ultrasound protocol is mandatory in all patients with NOM of spleen injuries for the early detection of potentially dangerous and fatal complications.
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Affiliation(s)
- Ivona Djordjevic
- Pediatric Surgery Clinic, Clinical Center, 18000 Nis, Serbia; (D.Z.); (A.K.); (D.D.)
- Faculty of Medicine, University of Nis, 18000 Nis, Serbia;
- Correspondence:
| | - Dragoljub Zivanovic
- Pediatric Surgery Clinic, Clinical Center, 18000 Nis, Serbia; (D.Z.); (A.K.); (D.D.)
- Faculty of Medicine, University of Nis, 18000 Nis, Serbia;
| | - Ivana Budic
- Faculty of Medicine, University of Nis, 18000 Nis, Serbia;
- Clinic for Anestesiology and Intensive Therapy, Clinical Center Nis, 18000 Nis, Serbia
| | - Ana Kostic
- Pediatric Surgery Clinic, Clinical Center, 18000 Nis, Serbia; (D.Z.); (A.K.); (D.D.)
| | - Danijela Djeric
- Pediatric Surgery Clinic, Clinical Center, 18000 Nis, Serbia; (D.Z.); (A.K.); (D.D.)
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Garrett HE, Mack L. Coil Embolization of Spontaneous Splenic Arteriovenous Fistula for Treatment of Portal Hypertension. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:386-390. [PMID: 28396581 PMCID: PMC5395133 DOI: 10.12659/ajcr.901845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Patient: Female, 64 Final Diagnosis: Splenic arteriovenous fistula Symptoms: Left lower quadrant abdominal pain Medication: — Clinical Procedure: Coiling embolization Specialty: Surgery
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Affiliation(s)
- H Edward Garrett
- Division of Vascular Surgery, University of Tennessee, Memphis, TN, USA
| | - Lamar Mack
- Division of Vascular Surgery, University of Tennessee, Memphis, TN, USA
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Oumar N, Dominique F, Nikola K, Pierre GM, Mamadou N, Benoit GR. Results of non-operative management of splenic trauma and its complications in children. J Indian Assoc Pediatr Surg 2014; 19:147-50. [PMID: 25197192 PMCID: PMC4155631 DOI: 10.4103/0971-9261.136468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Non-operative management (NOM) of splenic trauma in children is currently the treatment of choice. Purpose: We report a series of 83 cases in order to compare our results with literature data. Patients and Methods: For this, we conducted a retrospective study of 13 years and collected 83 cases of children with splenic trauma contusion, managed at Lapeyronie Montpellier Hospital in Visceral Pediatric Surgery Department. The studied parameters were age, sex, circumstances, the blood pressure (BP), hematology, imaging, associated injuries, transfusion requirements, treatment, duration of hospital stay, physical activity restriction and evolution. Results: NOM was successful in 98.7% of cases. We noted 4 complications including 3 pseudo aneurysms (PSA) of splenic artery and 1 pseudocyst spleen with a good prognosis. There was no mortality in our series. Conclusion: NOM is the treatment of choice for splenic trauma in children with a success rate of over 90%. Complications are rare and are dominated by the PSA of splenic artery.
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Affiliation(s)
- Ndour Oumar
- Department of Pediatric Surgery, Aristide Le Dantec Hospital, Dakar, Sénégal, France
| | - Forgues Dominique
- Department of Pediatric Urology and visceral surgery Pediatric Surgery of Lapeyronie Hospital Montpellier, France
| | - Kalfa Nikola
- Department of Pediatric Urology and visceral surgery Pediatric Surgery of Lapeyronie Hospital Montpellier, France
| | - Guibal Marie Pierre
- Department of Pediatric Urology and visceral surgery Pediatric Surgery of Lapeyronie Hospital Montpellier, France
| | - Ndoye Mamadou
- Department of Pediatric Surgery, Aristide Le Dantec Hospital, Dakar, Sénégal, France
| | - Galifer René Benoit
- Department of Pediatric Urology and visceral surgery Pediatric Surgery of Lapeyronie Hospital Montpellier, France
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Ding P, Li Z, Han XW, Wang ZG, Zhang WG, Fu MT. Portal, Mesenteric, and Splenic Vein Thromboses after Endovascular Embolization for Gastrointestinal Bleeding Caused by a Splenic Arteriovenous Fistula. Ann Vasc Surg 2014; 28:1322.e1-5. [DOI: 10.1016/j.avsg.2013.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 10/09/2013] [Accepted: 11/10/2013] [Indexed: 11/25/2022]
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Preserved function after angioembolisation of splenic injury in children and adolescents: a case control study. Injury 2014; 45:156-9. [PMID: 23246563 DOI: 10.1016/j.injury.2012.10.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 10/03/2012] [Accepted: 10/27/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Non-operative management for blunt splenic injuries was introduced to reduce the risk of overwhelming post splenectomy infection in children. To increase splenic preservation rates, splenic artery embolization (SAE) was added to our institutional treatment protocol in 2002. In the presence of clinical signs of ongoing bleeding, SAE was considered also in children. To our knowledge, the long term splenic function after SAE performed in the paediatric population has not been evaluated and constitutes the aim of the present study. METHODS A total of 11 SAE patients less than 17 years of age at the time of injury were included with 11 healthy volunteers serving as matched controls. Clinical examination, medical history, general blood counts, immunoglobulin quantifications and flowcytometric analysis of lymphocyte phenotypes were performed. Peripheral blood smears were examined for Howell-Jolly bodies (H-J bodies) and abdominal ultrasound was performed in order to assess the size and perfusion of the spleen. RESULTS On average 4.6 years after SAE (range 1-8 years), no significant differences could be detected between the SAE patients and their controls. Total and Pneumococcus serospecific immunoglobulins and H-J bodies did not differ between the study groups, nor did general blood counts and lymphocyte numbers, including memory B cell proportions. The ultrasound examinations revealed normal sized and well perfused spleens in the SAE patients when compared to their controls. CONCLUSION This case control study indicates preserved splenic function after SAE for splenic injury in children. Mandatory immunization to prevent severe infections does not seem warranted.
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Skattum J, Gaarder C, Naess PA. Splenic artery embolisation in children and adolescents--an 8 year experience. Injury 2014; 45:160-3. [PMID: 23137799 DOI: 10.1016/j.injury.2012.10.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 10/03/2012] [Accepted: 10/12/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Non-operative management (NOM) is the treatment of choice in blunt splenic injuries in the paediatric population, with reported success rates exceeding 90%. Splenic artery embolisation (SAE) was added to our institutional treatment protocol for splenic injury in 2002. We wanted to review indications for SAE and the clinical outcome of splenic injury management in children admitted between August 1, 2002 and July 31, 2010. METHODS Patients aged <17 years with splenic injury were identified in the institutional trauma and medical code registries. Patient charts and computed tomographic (CT) scans were reviewed. RESULTS Of the 72 children and adolescents with splenic injury included during the 8 year study period, 66 patients (92%) were treated non-operatively and six underwent operative management. Severe splenic injury (OIS grade 3-5) was diagnosed in 67 patients (93%). SAE was performed in 22 of the NOM patients. Indications for SAE included - bleeding (n=8), pseudoaneurysms (n=2), contrast extravasation (n=2), high OIS injury grade (n=8) and prophylactic due to specific disease (n=2). NOM was successful in all but one case (98%). For the patients aged ≤ 14 years, extravasation on initial CT scan correlated to delayed bleeding (p<0.001). Two SAE procedure specific complications were registered, but resolved without significant sequelae. CONCLUSION After SAE was added to the institutional treatment protocol, 22 of 66 NOM paediatric patients underwent SAE. NOM was successful in 98% and a 90% splenic preservation rate was achieved. Contrast extravasation correlated to delayed splenic bleeding in children ≤ 14 years.
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Affiliation(s)
- Jorunn Skattum
- Department of Traumatology, Oslo University Hospital Ullevaal, PO Box 4950, Nydalen, N-0424 Oslo, Norway.
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Martin K, Vanhouwelingen L, Bütter A. The significance of pseudoaneurysms in the nonoperative management of pediatric blunt splenic trauma. J Pediatr Surg 2011; 46:933-7. [PMID: 21616255 DOI: 10.1016/j.jpedsurg.2011.02.031] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 02/11/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Nonoperative management is the standard of care for hemodynamically stable pediatric and adult blunt splenic injuries. In adults, most centers follow a well-defined protocol involving repeated imaging at 24 to 48 hours, with embolization of splenic pseudoaneurysms (SAPs). In children, the significance of radiologically detected SAP has yet to be clarified. METHODS A systematic review of the medical literature was conducted to analyze the outcomes of documented posttraumatic SAP in the pediatric population. RESULTS Sixteen articles, including 1 prospective study, 4 retrospective reviews, and 11 case reports were reviewed. Forty-five SAPs were reported. Ninety-six percent of children were reported as stable. Yet, 82% underwent splenectomy, splenorrhaphy, or embolization. The fear of delayed complications owing to SAP was often cited as the reason for intervention in otherwise stable children. Only one child with a documented pseudoaneurysm experienced a delayed splenic rupture while under observation. No deaths were reported. CONCLUSIONS There is no evidence to support or dispute the routine use of follow-up imaging and embolization of posttraumatic SAP in the pediatric population. At present, the decision to treat SAP in stable children is at the discretion of the treating physician. A prospective study is needed to clarify this issue.
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Affiliation(s)
- Kathryn Martin
- Division of Pediatric Surgery, Children's Hospital, London Health Sciences Center, London, Ontario, Canada
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