Interventional procedure of percutaneous transhepatic vascular embolization for treating a mesenteric arteriovenous malformation in a patient with alcoholic liver cirrhosis, resulting in reduced portal pressure - Case study
A 66-year-old man, with a history of high alcohol intake and diagnosed with alcoholic cirrhosis, was found to have a mesenteric arteriovenous malformation (AVM) causing portal hypertension. The diagnosis was confirmed through abdominal contrast-enhanced CT, which revealed blunting of the liver edge, splenomegaly, and an anastomosis of the ileal artery and ileal vein via a nidus within the mesentery.
The patient presented with fatigue, and blood tests showed hepatic dysfunction. Despite these challenges, no abnormalities were found on physical examination. The man's medical history also included fatty liver, hypertension, hyperuricemia, and chronic gastritis. He tested negative for hepatitis B, hepatitis C virus, and antinuclear and antimitochondrial antibodies.
To treat the mesenteric AVM, the medical team opted for endovascular treatment, a less invasive approach compared to surgical intestinal resection. The ileal vein, which was the dominant outflow vein, was embolized, causing the blood flow in the AVM to disappear. Fortunately, there were no complications from the embolization.
This minimally invasive procedure, known as trans-arterial embolization, involves catheter-based delivery of embolic agents to block abnormal arterial feeders to the AVM, reducing shunt flow and portal hypertension. The results of the treatment were promising, as a decrease in portal pressure of 29% was confirmed post-embolization.
This case highlights the effectiveness of endovascular treatment for mesenteric AVMs causing portal hypertension. It is one of several key treatment modalities, including surgical resection or ligation, interventional radiology techniques, and pharmacologic options. The success of the treatment depends on the specifics of the AVM, the extent of portal hypertension, and the success of eliminating abnormal shunts.
In this instance, the 66-year-old patient experienced significant improvements, with a reduction in portal hypertension, decreased bleeding risks, and potential alleviation of symptoms. However, incomplete treatment or extensive malformations may require repeat procedures or combined modalities. A multidisciplinary approach involving interventional radiologists, surgeons, and hepatologists optimizes management.
- In light of the success of endovascular treatment for mesenteric AVMs, it's crucial to explore other health-and-wellness aspects for the 66-year-old patient to manage chronic-diseases like alcoholic cirrhosis, hypertension, and hyperuricemia effectively.
- Adequate skin-care, nutrition, and fitness-and-exercise regimens can contribute significantly to his overall health, potentially reducing the impact of chronic kidney disease and maintaining mental health.
- The patient should also regularly monitor his medical-conditions, especially for any signs of deterioration, and keep communication open with his healthcare providers to ensure proper management and treatment.
- As the patient progresses, it might be beneficial to consider additional interventions, such as surgical resection or ligation, when needed, in an effort to further alleviate his symptoms and improve his quality of life.
