E2327. Unusual Case of Spleno-Caval Shunt with Splenic Artery Aneurysm
Pinnamaneni Siddhartha Institute of Medical Sciences
A 73 year old male patient presented with recurrent episodes of drowsiness secondary to refractory hepatic encephalopathy for one year. He is a known Chronic Liver Disease with Portal hypertension and Chronic Kidney Disease for 35 years. On examination patient had flapping tremors. Abdominal CT scan revealed a large tortuous shunt between splenic vein and inferior vena cava and a calcified splenic artery aneurysm.
Educational Goals / Teaching Points
The imaging was performed using Siemens Biograph mCT 128 Slice CT Scanner. The interventional procedure was done in cathlab using GE Innova 41001Q machine.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The patient was planned for closure of spleno-caval shunt to reduce hepatic encephalopathy and emblolise splenic artery aneurysm which has a potential to bleed. The spleno-caval shunt was measured at various levels on the CT and successfully occluded by using the 20mm Amplatzer Vascular plug II by right transjugular approach. After three weeks partial embolization of splenic parenchyma was done using polyvinyl alcohol particles. Splenic artery aneurysm was embolized using glue followed by coil embolization of splenic artery across the neck of the aneurysm. On follow up patient symptoms that had been related to hepatic encephalopathy subsequently improved, was alert, ambulatory, showed disappearance of flapping tremors.
We conclude that transcatheter embolisation using vascular plugs is strongly recommended for embolisation of spleno-caval shunts. We recommend that the Amplatzer Vascular plug be used for embolization owing to its superior safety and utility when compared with other embolic materials.