Liver cirrhosis patient undergoes vascular embolization for mesenteric arteriovenous malformation, resulting in lowered portal pressure – Case Study
In a recent medical breakthrough, a 66-year-old man was successfully treated for a rare arteriovenous malformation (AVM) in the mesentery, which was causing portal hypertension.
The man, who had a history of fatty liver, hypertension, hyperuricemia, and chronic gastritis, presented with fatigue. Upon examination, no abnormalities were found, but further tests revealed an AVM connected to the ileal artery and ileal vein via a nidus within the mesentery.
On abdominal contrast-enhanced CT, blunting of the liver edge, splenomegaly, and this anastomosis were identified. Additionally, signs of cirrhosis and splenomegaly were observed in the liver on an abdominal ultrasound.
The man's laboratory test results, as presented in Table 1, were unremarkable, with negative results for hepatitis B, hepatitis C virus, and antinuclear and antimitochondrial antibodies.
In order to alleviate the portal hypertension symptoms and prevent complications, the patient's ileal vein was embolized during vascular embolization with a percutaneous transhepatic approach. The blood flow in the mesenteric AVM disappeared after the embolization, and a decrease in portal pressure of 29% was confirmed.
Endovascular treatment, such as percutaneous transhepatic vascular embolization, is thought to be a possible option compared to surgical intestinal resection. In cases of mesenteric AVMs that contribute to portal hypertension, treatment of the malformations can be expected to decrease portal pressure.
Treatment options for mesenteric AVMs causing portal hypertension primarily include endovascular therapies such as trans-arterial embolization, surgical ligation or resection, and, in some cases, medical management with agents like sirolimus if lymphatic components are involved.
Interventional radiology techniques, including image-guided embolization, are established treatments for vascular malformations, including AVMs, and play a crucial role in managing portal hypertension secondary to such malformations.
In complex or refractory cases involving vascular malformations with a lymphatic component, mTOR inhibitors such as sirolimus have shown promise by targeting vascular endothelial growth factor signaling, thus reducing malformation growth and symptoms, although this is more reported in conditions like primary intestinal lymphangiectasia rather than isolated mesenteric AVMs.
This case underscores the importance of early diagnosis and treatment of mesenteric AVMs, as these rare conditions can cause significant health issues if left untreated. The choice of treatment depends on AVM size, location, symptoms, and patient condition, with endovascular embolization and surgery being the mainstays of treatment.
- The success in treating the man's AVM shows progress in the field of medical-conditions, especially chronic-diseases like chronic-kidney-disease.
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