Departments of Vascular Surgery, Clínica Universidad de Navarra, Pamplona, Spain.
Departments of Interventional Radiology, Clínica Universidad de Navarra, Pamplona, Spain.
Diagn Interv Radiol. 2019 Mar;25(2):166-168. doi: 10.5152/dir.2019.18057.
Aneurysms of the portal vein and its branches have been rarely described. Their natural history is unknown although large ones (>3 cm in diameter) have been reported to cause rupture, thrombosis, duodenal or biliary obstruction, inferior vena cava compression and/or portal hypertension. We report the case of an incidentally diagnosed 4.5 cm splenic vein aneurysm repaired by endovascular treatment through a transhepatic route. The aneurysm was successfully excluded using a covered stent (Viabahn, Gore). The transhepatic route opens the possibility of offering a minimally invasive approach to vascular lesions of the portal vein system. Splenic vein aneurysms were first reported in 1953 (1) and they are part of the extrahepatic portal vein aneurysm group (2). Their mechanism of development is not well understood. Etiology may include congenital causes (inherent weakness of the vessel wall) or acquired causes (trauma, inflammation such as pancreatitis, liver disease, or portal hypertension). However, portal aneurysms do not seem to be the result of an isolated portal hypertension since they are extremely rare even in patients with this condition (3). The demographic characteristics of extrahepatic portal vein aneurysm include a female-to-male ratio of 2:1 and the median age of 52 years (range, 5-77 years). The size of the reported aneurysms ranges from 1.9 to 8 cm. The most common location of the aneurysm is in the main portal vein trunk, the junction of the superior mesenteric vein and the splenic vein, or at the hepatic hilus; intrahepatic venous aneurysms are rare (4, 5). Here, for the first time, we report the successful endovascular treatment of a splenic vein aneurysm through transhepatic percutaneous approach using a Viabahn stent.
门静脉及其分支的动脉瘤很少被描述。尽管已经报道了直径大于 3 厘米的大动脉瘤会导致破裂、血栓形成、十二指肠或胆道阻塞、下腔静脉压迫和/或门静脉高压，但它们的自然史尚不清楚。我们报告了一例偶然诊断的 4.5 厘米脾静脉动脉瘤，通过经肝途径进行血管内治疗修复。通过使用覆膜支架（Viabahn，戈尔）成功地排除了动脉瘤。经肝途径为门静脉系统血管病变提供了微创治疗的可能性。脾静脉动脉瘤于 1953 年首次报道（1），它们是肝外门静脉动脉瘤组的一部分（2）。其发病机制尚不清楚。病因可能包括先天性原因（血管壁固有弱点）或后天性原因（创伤、胰腺炎、肝病或门静脉高压等炎症）。然而，门静脉动脉瘤似乎不是孤立性门静脉高压的结果，因为即使在这种情况下，它们也极为罕见（3）。肝外门静脉动脉瘤的人口统计学特征包括女性与男性的比例为 2:1，中位年龄为 52 岁（范围为 5-77 岁）。报道的动脉瘤大小范围为 1.9 至 8 厘米。动脉瘤最常见的部位是门静脉主干、肠系膜上静脉与脾静脉交界处或肝门；肝内静脉动脉瘤很少见（4、5）。在这里，我们首次报告了一例通过经肝经皮途径使用 Viabahn 支架成功治疗脾静脉动脉瘤的病例。
