Interventional procedure of percutaneous transhepatic vascular embolization performed on a patient with alcoholic liver cirrhosis, who had a mesenteric arteriovenous malformation, resulting in reduced portal pressure - Case report presented
66-Year-Old Man Undergoes Successful Embolization for Mesenteric Arteriovenous Malformation
A 66-year-old man, with a history of high alcohol intake and diagnosed with alcoholic cirrhosis, presented with fatigue. No abnormalities were found during physical examination, but on abdominal contrast-enhanced CT, signs of cirrhosis, splenomegaly, and an anastomosis of the ileal artery and ileal vein via a nidus within the mesentery were identified.
The patient was diagnosed with portal hypertension from an arteriovenous malformation (AVM) in the mesentery. Blood tests revealed hepatic dysfunction, but results for hepatitis B, hepatitis C virus, antinuclear, and antimitochondrial antibodies were negative. The AVM was causing increased portal pressure by anastomosing the ileal artery and ileal vein via a nidus within the mesentery.
Vascular embolization with a percutaneous transhepatic approach was performed for the mesenteric AVM. The ileal vein, which was the dominant outflow vein, was embolized during the procedure. Following the embolization, a decrease in portal pressure of 29% was confirmed. The blood flow in the arteriovenous malformation disappeared, and there were no complications from the embolization procedure.
Endovascular treatment, such as percutaneous transhepatic vascular embolization, is thought to be a possible low-invasiveness option compared to surgical intestinal resection. In cases of mesenteric AVMs contributing to portal hypertension, treatment of the malformations can be expected to decrease portal pressure.
Treatment options for mesenteric AVMs causing portal hypertension include endoscopic coagulation/clipping, trans-arterial embolization, ligation and division of the feeding artery (LDFA), and surgical intestinal resection. Among these, minimally invasive interventions like embolization are often preferred initially due to lower morbidity compared to surgery.
While direct comparative data on success rates of embolization versus surgical resection specifically for mesenteric AVMs causing portal hypertension are sparse, trans-arterial embolization is effective in controlling bleeding and reducing shunting in many patients, leading to symptomatic improvement without the need for surgery in a significant proportion of cases.
Surgical intestinal resection is considered when embolization or other less invasive methods fail or when there is severe involvement of the bowel. This approach removes the affected segment of the intestine containing the AVM, which can definitively resolve the abnormal vascular communication contributing to portal hypertension. However, risks include postoperative complications and possible compromise of bowel function.
In summary, less invasive treatments like embolization are first-line options with good success in many cases. Surgical intestinal resection is reserved for refractory or severe cases and offers definitive treatment but with higher risk. Multidisciplinary management is essential to tailor therapy to the individual patient’s condition and minimize complications.
The search did not reveal detailed quantitative success rates or long-term outcomes comparing these modalities directly in this patient population, reflecting a gap in current evidence. (Table 1 presenting the detailed laboratory test results is not included due to the request for standalone facts.)
- The 66-year-old man, suffering from alcoholic cirrhosis, was diagnosed with chronic kidney disease due to an arteriovenous malformation (AVM) in the mesentery that caused portal hypertension.
- In the realm of health and wellness, managing chronic-diseases such as this man's chronic kidney disease could benefit from the application of medical-conditions-focused fitness-and-exercise plans to ensure overall improvement in his well-being.
- As interventional radiologists, we often consider embolization procedures, like the one performed on the man, as an initial, low-risk approach for treating chronic-diseases like chronic-kidney-disease related to mesenteric-AVMs, improving outcomes for a significant number of patients without the need for surgery.
