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Ruge A, Kumar N, Jose LK, Mahalmani V. Transarterial embolization of secondary inferior and superior mesenteric artery arteriovenous fistulas: a systematic review. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00878-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Acquired arteriovenous fistula are rare complications of a piercing injury, including a gunshot or knife injury, the rupture of a preexisting aneurysm into a neighboring vein, or a complication of arterial catheterization or abdominal surgical techniques, most often colonic resection. Our aim was to develop an online systematic review of the literature to determine all documented incidents of endovascular embolization of secondary mesenteric Arteriovenous Fistula, spanning key databases as well as pertinent publications, from 1982 to 2019. Our case was included as well. The primary objectives were technical success and death; the secondary outcomes were the frequency of complications and the advice of the operators.
Main body
Forty articles, comprising 41 patients, including our own, were reviewed. The superior mesenteric vessels are the most commonly affected by fistulas. Endovascularembolization was used in 80% of the cases. 100% of the patients had technical success. The intraoperative death rate was 0%, with a 90-day mortality rate of 8%, half of which was unrelated to the original pathology. More than 60% of patients who underwent successful treatments had no severe problems. All others had uneventful recoveries, with only 12% experiencing mild problems that were managed conservatively.
Conclusions
The majority of authors supported this therapeutic approach thereby making endovascular glue embolization the treatment of choice for superior mesenteric arteriovenous fistula and inferior mesenteric arteriovenous fistula in high risk patients and in patients with multiple co-morbidities.
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Cubisino A, Schembri V, Guiu B. Inferior mesenteric arteriovenous fistula with colonic ischemia: a case report and review of the literature. Clin J Gastroenterol 2021; 14:1131-1135. [PMID: 33837935 DOI: 10.1007/s12328-021-01411-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/01/2021] [Indexed: 11/26/2022]
Abstract
Inferior mesenteric arteriovenous fistula is a rare abnormal high flow communication with only 40 primary and secondary cases reported in literature. Shunting of arterial flow through the inferior mesenteric vein to the portal system can cause a variety of nonspecific clinical signs and symptoms usually associated with the diagnosis of arteriovenous malformation. Symptom intensities are flow-dependent and can range from minimal abdominal symptoms to severe heart failure due to left to right shunt. We report the case of a 72-year-old man without past history of abdominal surgery or trauma who was referred to our department for a 2-month history of intermittent diarrhea and abdominal pain caused by an arteriovenous fistula involving the left colic artery and the inferior mesenteric vein. A progressive and spontaneous improvement of symptoms and a control CT scan that confirmed the reduction of venous vascular engorgement and regression of parietal thickening of the left and sigmoid colon permitted a non-operative management.Inferior mesenteric arteriovenous fistula can be a rare cause of ischemic colitis and, if necessary, an appropriate treatment based on high clinical suspicion can reduce the risk of complications related to a missed diagnosis.
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Affiliation(s)
- Antonio Cubisino
- Division of HBP and Transplantation Surgery Unit, Department of Digestive Surgery and Transplantation, Saint-Eloi Hospital, University of Montpellier, 80 avenue Augustin Fliche, 34000, Montpellier, France.
| | - Valentina Schembri
- Department of Radiology, Saint-Eloi University Hospital, 80 Av. Augustin Fliche, 34000, Montpellier, France
| | - Boris Guiu
- Department of Radiology, Saint-Eloi University Hospital, 80 Av. Augustin Fliche, 34000, Montpellier, France
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Kai K, Sano K, Higuchi K, Uchiyama S, Sueta H, Nanashima A. A rare case of simultaneous rectal and gastric carcinomas accompanied with inferior mesenteric arterioportal fistula: case report. Surg Case Rep 2019; 5:82. [PMID: 31102060 PMCID: PMC6525223 DOI: 10.1186/s40792-019-0630-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/22/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Inferior mesenteric arterioportal fistula (APF) is rare as only 35 case reports in the literature. We herein presented a case of simultaneously double cancer in the rectum and stomach with inferior mesenteric APF, which is the first case report by searching using PubMed. Combination of interventional embolization and surgical operation seemed to be optimal treatment for avoiding postoperative complications and the curability. CASE PRESENTATION A 66-year-old male with epigastric pain was admitted to a practitioner. He underwent a gastroscopy with biopsy, and cancer located in the lesser curvature of the gastric cardia was found. Enhanced CT did not reveal wall thickening of the stomach and distant metastases, but several swollen lymph nodes were observed in the right cardia. In the arterial phase, dilation of inferior mesenteric vein (IMV) and superior rectal artery (SRA) were noted, which raised suspicions of an arterioportal communication. Colonoscopy revealed a type 2 rectal tumor located 12 cm from the anal verge. The histological diagnosis of well-differentiated tubular adenocarcinoma was confirmed by biopsy. At a first step, we planned to perform a radiological embolization of inflow vessels to APFs except for SRA. Additionally, we determined the interval time of 1 month between the first low anterior rectal resection and the sequential gastrectomy for the purpose of decreasing portal pressure. The postoperative course was uneventful without hemorrhagic complications, and S-1 was taken internally 1 year as adjuvant chemotherapy for gastric cancer. The patient still lives without recurrence of this cancer with APF and portal vein thrombosis 2.5 years after the aforementioned surgeries. CONCLUSION Inferior mesenteric APF and/or arteriovenous fistula (AVF) would be consisted of the several inflow arteries as superior rectal, internal iliac, and median sacral arteries, and outflow veins as inferior mesenteric, internal iliac, and median sacral veins. To determine the therapeutic strategy for left-sided colorectal cancers with abnormal vessel communications of the pelvis, it is significant to comprehend distribution and component vessels of APF and/or AVF.
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Affiliation(s)
- Kengo Kai
- Department of Surgery, Miyakonojo Medical Association Hospital, 1364-1 Tarobo, Miyakonojo, Miyazaki, 885-0002, Japan.
| | - Koichiro Sano
- Department of Surgery, Miyakonojo Medical Association Hospital, 1364-1 Tarobo, Miyakonojo, Miyazaki, 885-0002, Japan
| | - Kazuhiro Higuchi
- Department of Surgery, Miyakonojo Medical Association Hospital, 1364-1 Tarobo, Miyakonojo, Miyazaki, 885-0002, Japan
| | - Shuichiro Uchiyama
- Department of Surgery, Miyakonojo Medical Association Hospital, 1364-1 Tarobo, Miyakonojo, Miyazaki, 885-0002, Japan
| | - Hideto Sueta
- Department of Surgery, Miyakonojo Medical Association Hospital, 1364-1 Tarobo, Miyakonojo, Miyazaki, 885-0002, Japan
| | - Atsushi Nanashima
- Faculty of Medicine, Department of Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, Miyazaki, Japan
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Gelonch LM, Enríquez-Navascués JM, Bonel TP, Ansorena YS. Massive Left-sided Congestive Colitis Due to Idiopathic Inferior Mesenteric Arteriovenous Malformation. J Clin Imaging Sci 2017; 7:40. [PMID: 29142782 PMCID: PMC5672656 DOI: 10.4103/jcis.jcis_57_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 09/04/2017] [Indexed: 11/27/2022] Open
Abstract
Arteriovenous malformations (AVM) of the inferior mesenteric artery are rare. They may be primary (congenital or idiopathic) or secondary (acquired) after trauma or of iatrogenic origin. Of the abdominal AVM, the inferior mesenteric trunk is the least commonly involved. Most reported cases are of iatrogenic origin, resulting from colon surgery. Only 17 cases have been described and published in the literature. The objective of this work is to make known a case treated in our center. We present a case of 73-year old male, who came to the emergency service with symptoms of abdominal distension, pain lasting 48 hours along with months of diarrhoea. CT scan and an abdominal CT angiography showed a massive left-sided congestive colitis due to idiopathic inferior mesenteric arteriovenous malformation. In our case, the decision was to carry out the treatment in two stages. Embolisation was performed in the first stage in order to decrease the blood flow and the risk of intraoperative bleeding, followed by resective surgery of the affected colon.
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Affiliation(s)
- Laura Martí Gelonch
- Department of General Surgery, Hospital Universitario Donostia, San Sebastián, Spain
| | | | - Tania Pastor Bonel
- Department of General Surgery, Hospital Universitario Donostia, San Sebastián, Spain
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Poullos PD, Thompson AC, Holz G, Edelman LA, Jeffrey RB. Ischemic colitis due to a mesenteric arteriovenous malformation in a patient with a connective tissue disorder. J Radiol Case Rep 2014; 8:9-21. [PMID: 25926912 DOI: 10.3941/jrcr.v8i12.1843] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ischemic colitis is a rare, life-threatening, consequence of mesenteric arteriovenous malformations. Ischemia ensues from a steal phenomenon through shunting, and may be compounded by the resulting portal hypertension. Computed tomographic angiography is the most common first-line test because it is quick, non-invasive, and allows for accurate anatomic characterization. Also, high-resolution three-dimensional images can be created for treatment planning. Magnetic resonance angiography is similarly sensitive for vascular mapping. Conventional angiography remains the gold standard for diagnosis and also allows for therapeutic endovascular embolization. Our patient underwent testing using all three of these modalities. We present the first reported case of this entity in a patient with a vascular connective tissue disorder.
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Affiliation(s)
- Peter D Poullos
- Department of Radiology, Stanford University Hospital, Stanford, CA
| | - Atalie C Thompson
- Stanford University School of Medicine, Stanford, CA ; University of California, Berkeley, School of Public Health, Berkeley, California
| | - Grant Holz
- Department of Radiology, University of California Davis, Sacramento, CA
| | - Lauren A Edelman
- Department of Pathology, Stanford University Hospital, Stanford, CA
| | - R Brooke Jeffrey
- Department of Radiology, Stanford University Hospital, Stanford, CA
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Athanasiou A, Michalinos A, Alexandrou A, Georgopoulos S, Felekouras E. Inferior mesenteric arteriovenous fistula: Case report and world-literature review. World J Gastroenterol 2014; 20:8298-8303. [PMID: 25009407 PMCID: PMC4081707 DOI: 10.3748/wjg.v20.i25.8298] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 02/08/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
Arteriovenous fistulas between the inferior mesenteric artery and vein are rare, with only 26 primary and secondary cases described in the literature. Secondary fistulas occur following operations of the left hemicolon and manifest as abdominal pain, abdominal mass, gastrointestinal bleeding, colonic ischemia and portal hypertension. Symptom intensities are flow-dependent, and can range from minimal symptoms to severe heart failure due to left to right shunt. Diagnosis is usually established by radiological or intraoperative examination. Treatment options include embolization and/or surgical resection. Therapeutic decisions should be adapted to the unique characteristics of the fistula on an individual basis. A new case of a primary arteriovenous fistula is described and discussed along with a complete review of the literature. The patient in this report presented with signs and symptoms of colonic ischemia without portal hypertension. The optimal treatment for this patient required a combination of embolization and surgical operation. The characteristics of these rare inferior mesenteric arteriovenous fistulas are examined and some considerations concerning diagnostic and therapeutic strategies that should be followed are presented.
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Jeon DO, Park JS, Kim JE, Lee SJ, Cho HJ, Im SG, Kim ID, Han EM. [A case of traumatic inferior mesenteric arteriovenous fistula]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 62:296-300. [PMID: 24262596 DOI: 10.4166/kjg.2013.62.5.296] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Inferior mesenteric arteriovenous fistula is rare and may be congenital or acquired. Affected patients present with abdominal pain, mass, or manifestations of portal hypertension and bowel ischemia. Until now, inferior mesenteric arteriovenous fistula due to trauma has not been reported. Herein, we report a case of a 53-year-old woman who had inferior mesenteric arteriovenous fistula considered to have originated from remote blunt trauma that was successfully treated by surgical resection of only the arteriovenous fistula without colectomy. To our knowledge, this is the first case of traumatic inferior mesenteric arteriovenous fistula.
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Affiliation(s)
- Dong Ok Jeon
- Departments of Internal Medicine, Surgery and Pathology, Bundang Jesaeng General Hospital, Seongnam, Korea
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Brucher N, Moskovitch G, Otal P, Chaufour X, Rousseau H. Inferior mesenteric arteriovenous fistula treated by percutaneous arterial embolization: a breathtaking story! Diagn Interv Imaging 2013; 95:85-6. [PMID: 24183597 DOI: 10.1016/j.diii.2013.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- N Brucher
- Department of diagnostic and interventional imaging, Toulouse-Rangueil University Hospitals, Rangueil Hospital, 1, avenue du Pr-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex, France.
| | - G Moskovitch
- Department of diagnostic and interventional imaging, Toulouse-Rangueil University Hospitals, Rangueil Hospital, 1, avenue du Pr-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex, France
| | - P Otal
- Department of diagnostic and interventional imaging, Toulouse-Rangueil University Hospitals, Rangueil Hospital, 1, avenue du Pr-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex, France
| | - X Chaufour
- Department of vascular surgery and angiology, Toulouse-Rangueil University Hospitals, Rangueil Hospital, 1, avenue du Pr-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex, France
| | - H Rousseau
- Department of diagnostic and interventional imaging, Toulouse-Rangueil University Hospitals, Rangueil Hospital, 1, avenue du Pr-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex, France
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Kim IH, Kim DG, Kwak HS, Yu HC, Cho BH, Park HS. Ischemic colitis secondary to inferior mesenteric arteriovenous fistula and portal vein stenosis in a liver transplant recipient. World J Gastroenterol 2008; 14:4249-52. [PMID: 18636676 PMCID: PMC2725392 DOI: 10.3748/wjg.14.4249] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Arteriovenous fistula (AVF) involving the inferior mesenteric vessels is rare, and the affected patients usually present with abdominal pain, mass, or features of established portal hypertension. Colonic ischemia is a less common and more serious manifestation of AVF. We report a case of ischemic colitis secondary to inferior mesenteric AVF in a patient who underwent a previous liver transplantation, subsequently developed portal vein stenosis, and then presented with acute lower gastrointestinal bleeding. He underwent percutaneous transhepatic placement of a portal vein stent and left colectomy.
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