Related Experiment Videos
Splenic arteriovenous fistula
T E Brothers1, J C Stanley, G B Zelenock
1Department of Surgery, University of Michigan Medical Center, Ann Arbor, USA.
Insights
Splenic arteriovenous fistulas can cause severe issues, often presenting as gastrointestinal bleeding or portal hypertension. Operative intervention remains the optimal management strategy for these rare vascular anomalies.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Radiology
Background:
- Splenic arteriovenous fistulas (SAVFs) are rare vascular anomalies with significant morbidity.
- Understanding their etiology, presentation, and management is crucial for patient outcomes.
Observation:
- A comprehensive review of 91 patients with SAVFs was conducted.
- Common causes include atherosclerotic aneurysm rupture (44%), congenital malformations (20%), and post-splenectomy (13%).
Findings:
- Gastrointestinal hemorrhage (48%) and chronic portal hypertension (65%) were the most frequent manifestations.
- Congenital fistulas and proximal locations were associated with higher rates of gastrointestinal hemorrhage (p < 0.05).
- Management primarily involved splenectomy (70%) and fistula excision (59%), with operative intervention being optimal.
Implications:
- This review highlights the critical need for timely diagnosis and appropriate management of SAVFs.
- Optimal treatment strategies focus on operative intervention, with percutaneous embolization as an adjunct in select cases.
- Further research into less invasive treatment options may be warranted.
Abstract:
Splenic arteriovenous fistulas are uncommonly encountered, yet they can invoke serious pathophysiological consequences. Four patients treated for splenic fistulas at our institution over the last decade were combined with all previous case reports to produce the most extensive review yet reported, totalling 91 patients. Common etiologies included atherosclerotic aneurysm rupture (44%), congenital malformation (20%), and prior splenectomy (13%). The most frequent manifestation was gastrointestinal hemorrhage (48%), which was most prevalent with congenital fistulas (61% p < 0.05) or fistulas located proximally (54%, p < 0.005). Chronic portal hypertension that was usually characterized by preservation of hepatic function developed in 65%. Management included splenectomy (70%), fistula excision (59%), and occasionally required distal pancreatectomy (10%). Persistent portal hypertension necessitated operative portosystemic shunting in select cases (9%), with an overall 30 day operative mortality of 9%. While percutaneous embolization provided an additional therapeutic option in 4%, optimal management continues to include operative intervention.