Portal hypertension secondary to an arteriovenous fistula between the celiac trunk and the splenic vein with the formation of extensive portosystemic collaterals involving the iliolumbar and testicular veins

The article presents a unique case of a congenital arteriovenous fistula between the celiac trunk and the splenic vein in a 47-year-old patient, leading to the formation of a high-flow arteriovenous shunt and the development of pronounced portal hypertension. The prolonged shunting of arterial blood into the portal vein system resulted in a significant increase in venous pressure and blood volume, stimulating the formation of compensatory portosystemic collaterals. A distinctive feature of this case was the development of highly atypical retroperitoneal drainage pathways involving the iliolumbar and testicular veins, as well as the formation of a prominent varix of the left renal vein. These changes reflect chronic venous overload and long-standing portal hypertension, which has not been previously described in the medical literature. The findings underscore the critical role of angiographic methods in diagnosing rare congenital vascular anomalies and assessing their hemodynamic consequences. This case highlights the necessity of an individualized approach to patients with portal hypertension of unclear etiology and emphasizes the importance of considering congenital arteriovenous malformations as a possible, albeit extremely rare, causative factor. The presented case expands current understanding of the clinical manifestations and morphofunctional changes associated with high-flow arteriovenous fistulas of visceral vessels and serves as a basis for discussing strategies for the diagnosis and management of such patients.