Liver cirrhosis patient undergoes vascular embolization to manage mesenteric arteriovenous malformation for reduced portal pressure - Case Study
A 66-year-old man presented with fatigue, and after thorough examination, a diagnosis of portal hypertension due to an arteriovenous malformation (AVM) in the mesentery was confirmed. This condition, which can occasionally cause portal hypertension, was identified through abdominal contrast-enhanced computed tomography (CT) scans, which revealed blunting of the liver edge and splenomegaly. Further investigation revealed an anastomosis of the ileal artery and ileal vein via a nidus within the mesentery.
The man's medical history included fatty liver, hypertension, hyperuricemia, and chronic gastritis. He also had a history of high alcohol intake, leading to alcoholic cirrhosis. On abdominal ultrasound, coarsened echotexture, surface nodularity, and hypertrophy of the caudate and lateral segment with volume loss of the right lobe were seen, suggesting cirrhosis. Splenomegaly was also observed, but no ascites were present.
In the early phase of contrast-enhanced CT, there was contrast enhancement in the ileal vein at the same level as the artery, indicating a mesenteric AVM. Blood tests showed hepatic dysfunction, but the man tested negative for hepatitis B, hepatitis C virus, and antinuclear and antimitochondrial antibodies.
Percutaneous transhepatic vascular embolization, a minimally invasive technique, was performed for the mesenteric AVM. This approach can be effective in managing AVMs causing portal hypertension by occluding abnormal vessels to reduce portal pressure and bleeding risk. Compared to surgical intestinal resection, embolization offers the potential benefits of less invasiveness, preservation of bowel integrity, and shorter recovery time.
The ileal vein, which was the dominant outflow vein, was embolized, causing the blood flow in the AVM to disappear. A decrease in portal pressure of 29% was confirmed after the embolization. No complications from the embolization were reported.
Due to limited direct comparison studies specifically on mesenteric AVMs causing portal hypertension, the choice between embolization and surgery typically depends on the patient's hepatic function and overall status, size and location of the AVM, and potential complications of each treatment. Embolization may be favored initially for its less invasive profile and ability to be repeated if necessary. Surgery remains important for definitive treatment, especially if embolization is incomplete or complications arise.
In conclusion, percutaneous transhepatic vascular embolization is an effective, less invasive alternative to surgical resection for treating mesenteric AVMs causing portal hypertension, offering potential benefits of reduced morbidity and bowel preservation, though it may carry a moderate risk of re-bleeding. Decision-making should be individualized based on patient and lesion characteristics.
[1] Reference omitted for brevity.
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