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Wang H, Zheng K, Nie Q, Yang B, Fan X, Liu P, Ye Z. Endovascular comprehensive treatment of post-traumatic superior mesenteric arteriovenous fistula: case report and literature review. Front Cardiovasc Med 2024; 11:1414395. [PMID: 38988664 PMCID: PMC11233816 DOI: 10.3389/fcvm.2024.1414395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/06/2024] [Indexed: 07/12/2024] Open
Abstract
Background Superior mesenteric arteriovenous fistula is a rare and difficult complication after abdominal trauma. Utilizing comprehensive endovascular treatment represents an effective approach to managing this condition. Case presentation We report a case involving a 53-year-old female with a history of trauma who presented with complaints of abdominal pain, malaise, and melena. A computed tomographic scan revealed the presence of a superior mesenteric arteriovenous fistula. The fistula was occluded using four Interlock detachable coils, and a covered stent was positioned over the arteriovenous fistula in the superior mesenteric artery. Following endovascular treatment, the patient's abdominal pain and melena symptoms disappeared. Conclusion Utilizing covered stents and Interlock detachable coils for endovascular treatment of a superior mesenteric arteriovenous fistula proves to be both feasible and highly effective.
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Affiliation(s)
- Hongxin Wang
- Department of Interventional Therapy, The First Dongguan Affiliated Hospital of Guangdong Medical University, Dongguan, Guangdong, China
| | - Kai Zheng
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qiangqiang Nie
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Bo Yang
- Department of Vascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xueqiang Fan
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Peng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Zhidong Ye
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
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Arteriovenous Fistula of Superior Mesenteric Artery: An Unusual Cause of an Massive Lower Gastrointestinal Bleeding. Int Surg 2021. [DOI: 10.9738/intsurg-d-17-00014.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction
The most common causes of lower gastrointestinal (GI) hemorrhage are diverticulosis and angiodysplasia. Arteriovenous fistula (AVF) of the intestine is an uncommon cause of GI hemorrhage.
Case Presentation
Herein, we report a case of an embolization of an AVF originated from the superior mesenteric artery and vein as a cause of acute massive lower GI bleeding.
Conclusion
The patient underwent a right hemicolectomy and ileotransversostomy.
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Wong AHC, Leung WKW, Kan WK. Endovascular treatment of iatrogenic superior mesenteric arteriovenous fistula resulting in recurrent abdominal ascites. BJR Case Rep 2021; 7:20200205. [PMID: 34131506 PMCID: PMC8171129 DOI: 10.1259/bjrcr.20200205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/12/2021] [Accepted: 01/20/2021] [Indexed: 11/05/2022] Open
Abstract
Superior mesenteric arteriovenous fistulas (AVFs) are rare and are usually caused by previous bowel surgery or blunt abdominal trauma. Patients may be asymptomatic, have non-specific symptoms of abdominal pain, nausea and vomiting or present with symptoms of portal hypertension; some patients may present years after initial surgery or trauma. Traditionally, superior mesenteric AVFs are treated by surgical ligation. However, percutaneous endovascular treatment has become increasingly popular in recent years. Different options of endovascular treatment include coil embolisation, covered stent and vascular plugs. There is a risk of coil migration with coil embolisation and covered stents may cause abnormal vessel straightening. Vascular plugs allow the fistula to be treated with fewer devices and have minimal risk of migration. Newer devices such as microvascular plugs have the added advantage of being able to be delivered through microcatheters or diagnostic catheters. The smaller profile of the microvascular plug also allows it to navigate through tortuous vessels. We report a case of a 77-year-old patient presenting with recurrent abdominal ascites three years after small bowel resection. CT and angiogram demonstrated a superior mesenteric AVF, which was successfully treated with a combination of microvascular plug and coil. He remained relatively asymptomatic four months after treatment.
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Affiliation(s)
- Amy Ho Ching Wong
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Warren K W Leung
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Wai Kuen Kan
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
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Hanrahan TP, Goodwin M, Testro A. An Extraordinary Cause of Dyspnea and Weight Loss. Gastroenterology 2021; 160:e19-e20. [PMID: 32673693 DOI: 10.1053/j.gastro.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Timothy P Hanrahan
- Liver and Intestinal Transplant Unit, Austin Health, Melbourne, Victoria, Australia.
| | - Mark Goodwin
- Department of Radiology, Austin Health, Melbourne, Victoria, Australia
| | - Adam Testro
- Liver and Intestinal Transplant Unit, Austin Health, Melbourne, Victoria, Australia
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Zhao Y, Xie B, Liu Q, Luo R, Wan Y, Malik K, Civilini E. Endovascular Treatment of Post-traumatic Superior Mesenteric Arteriovenous Fistula: A Case Report. Ann Vasc Surg 2018. [PMID: 29518505 DOI: 10.1016/j.avsg.2017.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Superior mesenteric arteriovenous fistulae (SMAVFs) are extremely rare with no consensus about therapeutic indications and optimal approach. Here, we present a case of a symptomatic SMAVF found in a young patient a few years after a penetrating abdominal injury. Following a complex clinical management of the acute status, we successfully managed the fistula with 3 covered stents in 2 consecutive endovascular procedures. Technical details of the performed procedures, including the main pitfalls and chosen solutions, have been explored and discussed.
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Affiliation(s)
- Yanping Zhao
- Department of Vascular Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, P.R. China
| | - Bin Xie
- Department of General Surgery, Ji'an Central Hospital, Ji'an City, P.R. China
| | - Qiang Liu
- Department of Vascular Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, P.R. China
| | - Rongguang Luo
- Department of Vascular Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, P.R. China
| | - Yanna Wan
- Department of Vascular Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, P.R. China
| | - Karolina Malik
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Efrem Civilini
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy; Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
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Hussein M, Issa G, Muhsen S, Haydar A. Superior mesenteric arteriovenous fistula embolisation complicated by bowel ischaemia. BMJ Case Rep 2013; 2013:bcr-2013-009521. [PMID: 23682091 DOI: 10.1136/bcr-2013-009521] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Superior mesenteric arteriovenous fistulas are rare, especially when iatrogenic in origin. Management of these fistulas can be surgical or endovascular. Endovascular embolisation is the preferred modality with a low rate of complications. Among the reported complications, bowel ischaemia is considered an unlikely occurrence. We report a case of a complex iatrogenic arterioportal fistula that was managed by endovascular embolisation and controlled through both its inflow and outflow, and was later complicated by bowel ischaemia.
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Affiliation(s)
- Maher Hussein
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Transcatheter coil embolization of an iatrogenic superior mesenteric arteriovenous fistula: report of a case. Surg Today 2011; 41:556-9. [PMID: 21431493 DOI: 10.1007/s00595-010-4306-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 02/09/2010] [Indexed: 10/18/2022]
Abstract
A 37-year-old male patient presented with abdominal pain and diarrhea. Computed tomography showed a large superior mesenteric vein aneurysm. The patient had a history of Crohn's disease and underwent an ileocecal resection 7 years previously. A selective angiogram of the superior mesenteric artery revealed that a dilated branch of this artery fed directly into the superior mesenteric vein. The iatrogenic superior mesenteric arteriovenous fistula was successfully closed by transarterial coil embolization. Successful endovascular treatment for a superior mesenteric arteriovenous fistula has been recently reported; however, the complications of this new modality are not well understood. We herein review the current literature and discuss endovascular treatment.
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Abstract
OBJECTIVE Arteriovenous fistulas (AVFs) are abnormal communications with shunting of blood from an artery to a vein. AVFs mainly involve the peripheral vascular system but can affect virtually any organ or system in the body. They may be congenital, created surgically for hemodialysis, or caused by pathologic processes. This review describes the diverse origins of AVFs and illustrates the spectrum of imaging findings at radiography, ultrasound, CT, MRI, and digital angiography for AVFs in different locations: the CNS, thorax, abdomen, musculoskeletal system, and peripheral vascular system. We also discuss syndromes associated with AVFs and describe recent interventional techniques for treating AVFs. CONCLUSION Familiarity with the spectrum of imaging findings in AVFs is essential for the accurate interpretation of images and facilitates diagnosis and therapeutic management. Radiologists can play a critical role in the diagnosis and treatment of AVFs. Digital angiography is helpful in elaborating a vascular map for endovascular treatment.
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Chiriano J, Teruya T, Zhang W, Abou-Zamzam A, Bianchi C. Treatment of Superior Mesenteric Artery Portal Vein Fistula with Balloon-Expandable Stent Graft. Ann Vasc Surg 2009; 23:99-102. [DOI: 10.1016/j.avsg.2008.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 09/30/2008] [Accepted: 10/07/2008] [Indexed: 11/26/2022]
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10
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Yeo KK, Dawson DL, Brooks JL, Laird JR. Percutaneous treatment of a large superior mesenteric artery pseudoaneurysm and arteriovenous fistula: A case report. J Vasc Surg 2008; 48:730-4. [DOI: 10.1016/j.jvs.2008.03.056] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 03/23/2008] [Accepted: 03/29/2008] [Indexed: 12/30/2022]
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11
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Wu CG, Li YD, Li MH. Post-traumatic superior mesenteric arteriovenous fistula: Endovascular treatment with a covered stent. J Vasc Surg 2008; 47:654-6. [DOI: 10.1016/j.jvs.2007.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Revised: 10/04/2007] [Accepted: 10/06/2007] [Indexed: 10/22/2022]
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12
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Xu CE, Guo L, Li GX, Zhang SG, Yu ZH, Ruan CL. A Rare Case of Superior Mesenteric Arterio-venous Fistula Causing Jejunal Varices and Recurrent GI Bleeding. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.ejvsextra.2006.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Mick SL, Bush HL, Barie PS. Superior mesenteric arteriovenous fistula causing massive hematemesis. Surgery 2003; 134:102-4. [PMID: 12874590 DOI: 10.1067/msy.2003.11] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Stephanie L Mick
- Department of Surgery, New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, NY 10021, USA
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