Percutaneous transhepatic vascular embolization for a mesenteric arteriovenous malformation leading to decreased portal pressure in a patient with alcoholic liver cirrhosis: A case report

Arteriovenous malformations in the abdominal region are rare, and they are known to occasionally cause portal hypertension. A 66-year-old man with a chief complaint of fatigue and blood tests showing hepatic dysfunction was seen for a more detailed examination. Abdominal contrast-enhanced computed tomography showed an anastomosis of the ileal artery and ileal vein via a nidus within the mesentery. In addition to alcoholic cirrhosis from a history of high alcohol intake, the patient was diagnosed with portal hypertension from increased portal pressure due to an arteriovenous malformation in the mesentery. Vascular embolization with a percutaneous transhepatic approach was performed for the mesenteric arteriovenous malformation. The ileal vein, which was the dominant outflow vein, was embolized, and the blood flow in the arteriovenous malformation disappeared. A decrease in portal pressure of 29% was confirmed. There were no complications from the embolization. In cases of mesenteric arteriovenous malformations that contribute to portal hypertension, treatment of the malformations can be expected to decrease portal pressure. Compared with surgical intestinal resection, endovascular treatment that can be done with low invasiveness is thought to be a possible option.