Portosystemic arteriovenous fistula. Case report

A case of the rare portosystemic arteriovenous fistula is presented. This lesion, although basically simple, is not trivial. The predominant cause of death is variceal bleeding. Most often, the fistulas are due to rupture of an aneurysm of the hepatic or splenic artery, gunshot wound of the abdomen, or the use of mass ligature during abdominal surgery. The treatment is excision when possible, reconstruction of the vessels when vessels cannot be sacrificed, and ligation when everything else fails. Angiography is indispensible in defining the fistula. Because of the circulatory strain produced by these fistulas and of the danger of portal hypertension even in the asymptomatic patient, the presence of a portosystemic arteriovenous fistula is sufficient indication for surgical treatment.