Abstract
BackgroundAbernethy malformation is a rare condition defined by a congenital extrahepatic portosystemic shunt, often leading to absence or hypoplasia of the intrahepatic portal venous system. Although there are no consensus treatment guidelines, interventional techniques now offer minimally invasive treatment options for Abernethy malformations. This case report describes a case of Abernethy Syndrome Type II where the patient had two separate extrahepatic portosystemic shunts treated with endovascular occlusion with two Amplatzer plugs and demonstrates the feasibility of this treatment for this rare condition. This case was in a young adult, adding to the scarce literature of treatment for Abernethy syndrome in the adult population.Case presentationWe report a case of a 20-year-old female patient with neurocognitive behavioral difficulty, voracious appetite, and chronic encephalopathy secondary to type II Abernethy malformation with not one, but two extrahepatic portosystemic shunts. The patient had failed medical management and was not a liver transplant candidate. Therefore, she presented to us for an endovascular treatment option. The two shunts were treated with endovascular occlusion using Amplatzer vascular plugs. Following embolization, flow into the hypoplastic portal vein improved with near complete occlusion of flow into the portosystemic shunts, thus restoring blood flow into the native portal system. At 3 month follow up, a CT demonstrated complete occlusion of the two portosystemic shunts, and a portal vein diminutive in caliber. The portal vein measured 7 mm in diameter on both pre and post-procedure CT scans. The total volume of the liver was found to be 843 cm3 on pre-procedure CT & 1191 cm3 on post-procedure CT.ConclusionsThis report demonstrates the feasibility of using endovascular embolization to treat Abernethy II malformations. The management strategy of Type II Abernethy Syndrome should be to redirect blood flow into the hypoplastic native portal system, allowing for physiologic hepatic metabolism of splanchnic blood, hypertrophy of the portal system, and growth of the liver from the increased trophic flow.
Highlights
Abernethy malformation is a rare condition defined by a congenital extrahepatic portosystemic shunt
Type II malformations have a hypoplastic portal vein which leads to at least some of the portal blood flow diverting into the systemic circulation (Fig. 1). (Papamichail et al 2018; Alonso-Gamarra et al 2011)
The current literature describes closure of extrahepatic portal shunts using a variety of materials including atrial septal occluder devices, VSD occluder devices, Amplatzer vascular plugs, n-butyl cyanoacrylate, coils, and microcoils. (Papamichail et al 2018; Venkateshwaran et al 2014; Rajeswaran et al 2020; Loureiro et al 2021; Grimaldi et al 2012; Suzuki et al 2013; Yoshimatsu et al 2006) Rajeswaran et al retrospectively studied patients with congenital portosystemic shunts treated by either operative ligation, endovascular occlusion, combined surgical & endovascular closure, and observation
Summary
Abernethy malformation is a rare condition defined by a congenital extrahepatic portosystemic shunt. Conclusions: This report demonstrates the feasibility of using endovascular embolization to treat Abernethy II malformations. (Papamichail et al 2018; Venkateshwaran et al 2014; Rajeswaran et al 2020; Loureiro et al 2021; Grimaldi et al 2012; Suzuki et al 2013; Yoshimatsu et al 2006) Rajeswaran et al retrospectively studied patients with congenital portosystemic shunts treated by either operative ligation, endovascular occlusion, combined surgical & endovascular closure, and observation.
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