Unusual Case of Splenocaval Shunt with Splenic Artery Aneurysm

Purpose: A 73-year-old man presented with recurrent episodes of drowsiness secondary to refractory hepatic encephalopathy for 1 year. He was known to have chronic liver disease with portal hypertension and chronic kidney disease for 35 years. On examination, the patient had flapping tremors. Abdominal computed tomography (CT) revealed a large tortuous shunt between the splenic vein and inferior vena cava and a calcified splenic artery aneurysm.

Materials and Methods: Imaging was performed using Siemens Biograph mCT 128 Slice CT Scanner. The interventional procedure was done in the cath lab using a GE Innova 41001Q machine.

Results: The patient was planned for closure of splenocaval shunt to reduce hepatic encephalopathy and embolize the splenic artery aneurysm, which has a potential to bleed. The splenocaval shunt was measured at various levels on CT and successfully occluded using a 20-mm Amplatzer Vascular plug II with a right transjugular approach. After 3 weeks, partial embolization of the splenic parenchyma was done using polyvinyl alcohol particles. The splenic artery aneurysm was embolized using glue followed by coil embolization of the splenic artery across the neck of the aneurysm. On follow-up, the patient’s hepatic encephalopathy–related symptoms subsequently improved; he was alert and ambulatory and showed disappearance of flapping tremors.

Conclusions: We conclude that transcatheter embolization using vascular plugs is strongly recommended for embolization of splenocaval shunts. We recommend that the Amplatzer Vascular plug be used for embolization owing to its superior safety and utility compared with other embolic materials.