Bleeding from esophageal varices exacerbated by splenic arterial-venous fistula: complete transcatheter obliterative therapy.
A cirrhotic patient who had previously undergone both mesocaval shunting and transthoracic esophageal and gastric devascularization with splenectomy (Sugiura procedure) presented with recurring intractable variceal hemorrhage. Diagnostic visceral angiography demonstrated a large splenic arterial-venous fistula and gastroesophageal varices. Transarterial occlusion of the fistula and transheptic obliteration of the varices successfully done at one sitting prevented further bleeding. Follow-up angiography nine months later revealed persistent occlusion of the previous fistula and no evidence of esophageal varices.
D001164:Arteriovenous Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D002404:Catheterization; D004621:Embolization, Therapeutic / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013157:Splenic Artery / Q000000981:diagnostic imaging; D013162:Splenic Vein / Q000000981:diagnostic imaging