Portal Venous Aneurysm: About One Case Treated by Resection and Aortic Allograft and Review of Literature
J Batellier | D Castaing
Seance of wednesday 11 october 2017 (COMMUNICATIONS LIBRES)
DOI number : 10.26299/m1jq-2n04/emem.2017.4.014
Abstract
Portal Vein Aneurysms (PVA) are rare and estimated to be 3% of venous aneurysms. Their frequency is estimated to be 0.43% in a review of 4186 patients. Two types of PVA are described: congenital aneurysm and acquired aneurysm. Congenital aneurysm is due to a wrong fusion of right and left vitelline veins, leading to a sacciform
or fusiform aneurysm. Acquired aneurysms are related to a chronic hepatic disease (cirrhosis with or without portal hypertension) or a chronic pancreatitis.
We present an observation of a 38 years old woman, without any background (no pregnancy, no oral anticonceptraceptive). A PVA was diagnosed by explorations of abdominal pains and weigh loss of 8 kg in six months. Biologic explorations did not show any abnormalyties of hepatic function. Color dupplex scan and angio CT scan showed a PVA. It was a fusiform aneurysm and measured 52mm / 38 mm. The portal bifurcation was respected on 13 mm before the bifurcation. Diameter evolutivity from 38 mm to 48 mm was diagnosed by duplex scan and RMI, between February and May 2015.
After multi-disciplinary consensus conference and literature review, we decided to operate the patient in a reference center (Centre Hépato Biliaire - Hôpital Paul Brousse). The aneurysm was resected and the reconstruction was done with an aortic allograft (Pr Castaing). Post-operative course was uneventful. Anticoagulant therapy (HBPM), replaced by Coumadin after a month was used. This treatment was interrupted at six months. Dupplex scan and CT scan showed patency of the graft at 12 months, with a short occlusion of the splenic vein. With an 18 month follow up, patient was asymptomatic, has recovered her weight and returned to farmer activity.
We present:
• an exhaustive review of French and English literature by Pubmed Medline for the last 15 years;
• with two tables, we review 22 clinical cases, according to indications, surgical technique and results;
• we analyze the treatment of thrombosed aneurysms.
• this clinical case and an extensive review of the literature allows to discuss the surgical modalitys of treatment.
or fusiform aneurysm. Acquired aneurysms are related to a chronic hepatic disease (cirrhosis with or without portal hypertension) or a chronic pancreatitis.
We present an observation of a 38 years old woman, without any background (no pregnancy, no oral anticonceptraceptive). A PVA was diagnosed by explorations of abdominal pains and weigh loss of 8 kg in six months. Biologic explorations did not show any abnormalyties of hepatic function. Color dupplex scan and angio CT scan showed a PVA. It was a fusiform aneurysm and measured 52mm / 38 mm. The portal bifurcation was respected on 13 mm before the bifurcation. Diameter evolutivity from 38 mm to 48 mm was diagnosed by duplex scan and RMI, between February and May 2015.
After multi-disciplinary consensus conference and literature review, we decided to operate the patient in a reference center (Centre Hépato Biliaire - Hôpital Paul Brousse). The aneurysm was resected and the reconstruction was done with an aortic allograft (Pr Castaing). Post-operative course was uneventful. Anticoagulant therapy (HBPM), replaced by Coumadin after a month was used. This treatment was interrupted at six months. Dupplex scan and CT scan showed patency of the graft at 12 months, with a short occlusion of the splenic vein. With an 18 month follow up, patient was asymptomatic, has recovered her weight and returned to farmer activity.
We present:
• an exhaustive review of French and English literature by Pubmed Medline for the last 15 years;
• with two tables, we review 22 clinical cases, according to indications, surgical technique and results;
• we analyze the treatment of thrombosed aneurysms.
• this clinical case and an extensive review of the literature allows to discuss the surgical modalitys of treatment.