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Dzhagraev KR, Muslimov RS, Klimov AB, Ryabukhin VE, Kim TE, Selina IE, Kiryushchenkov VP, Moskalenko VA, Kokov LS. Endovascular Occlusion of Giant Posttraumatic Pseudo-Aneurysm of Superior Mesenteric Artery Connected to Mesenteric Arteriovenous Fistula. Sovrem Tekhnologii Med 2021; 12:55-61. [PMID: 34795993 PMCID: PMC8596274 DOI: 10.17691/stm2020.12.4.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Indexed: 11/27/2022] Open
Abstract
The aim of the study was to show the capabilities of endovascular occlusion of giant posttraumatic pseudo-aneurysm of superior mesenteric artery (SMA) connected to a mesenteric arteriovenous fistula (AVF) under the conditions of portal hypertension and life-threatening esophageal variceal bleeding.
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Affiliation(s)
- K R Dzhagraev
- Leading Researcher, Department of Emergency Surgery, Endoscopy and Resuscitation; N.V. Sklifosovsky Research Institute of Emergency Care, 3 Bolshaya Sukharevskaya Square, Moscow, 129090, Russia; Associate Professor, Department of Emergency and General Surgery; Russian Medical Academy of Continuous Professional Education, 2/1, Bldg 1, Barrikadnaya St., Moscow, 125993, Russia
| | - R Sh Muslimov
- Leading Researcher, Department of Radiation Diagnostics; N.V. Sklifosovsky Research Institute of Emergency Care, 3 Bolshaya Sukharevskaya Square, Moscow, 129090, Russia
| | - A B Klimov
- Physician, Department of X-ray Surgery Diagnosis and Therapy; N.V. Sklifosovsky Research Institute of Emergency Care, 3 Bolshaya Sukharevskaya Square, Moscow, 129090, Russia
| | - V E Ryabukhin
- Physician, Department of X-ray Surgery Diagnosis and Therapy; N.V. Sklifosovsky Research Institute of Emergency Care, 3 Bolshaya Sukharevskaya Square, Moscow, 129090, Russia
| | - T E Kim
- Physician, 2 Surgery Department; N.V. Sklifosovsky Research Institute of Emergency Care, 3 Bolshaya Sukharevskaya Square, Moscow, 129090, Russia
| | - I E Selina
- Leading Researcher, Department of Radiation Diagnostics; N.V. Sklifosovsky Research Institute of Emergency Care, 3 Bolshaya Sukharevskaya Square, Moscow, 129090, Russia
| | - V P Kiryushchenkov
- Physician, Department of X-ray Surgery Diagnosis and Therapy; N.V. Sklifosovsky Research Institute of Emergency Care, 3 Bolshaya Sukharevskaya Square, Moscow, 129090, Russia
| | - V A Moskalenko
- Physician, Department of X-ray Surgery Diagnosis and Therapy; N.V. Sklifosovsky Research Institute of Emergency Care, 3 Bolshaya Sukharevskaya Square, Moscow, 129090, Russia
| | - L S Kokov
- Professor, Academician of the Russian Academy of Sciences, Head of the Department of Radiation Diagnostics; N.V. Sklifosovsky Research Institute of Emergency Care, 3 Bolshaya Sukharevskaya Square, Moscow, 129090, Russia; Head of the Radiodiagnosis Department, Institute of Professional Education I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya St., Moscow, 119991, Russia
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Wild J, Kos X, Delasau I. Rare case of superior mesenteric artery pseudoaneurysm and arteriovenous fistula following blunt abdominal trauma. ANZ J Surg 2019; 90:917-919. [PMID: 31522457 DOI: 10.1111/ans.15428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Jeremy Wild
- Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, New Zealand
| | - Xavier Kos
- Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand
| | - Ilaitia Delasau
- Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, New Zealand
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ding W, Li J, Ni L, Zhao K, Ji W, Li N, Wu X. Comparisons of three surgical procedures on intestine ischemia reperfusion injury in a superior mesenteric artery injury model. J Surg Res 2009; 168:119-26. [PMID: 20031161 DOI: 10.1016/j.jss.2009.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 06/22/2009] [Accepted: 07/07/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Temporary ligation, primary anastomosis, and temporary shunt have been reported to deal with superior mesenteric artery (SMA) injuries. We aimed to investigate which brought minimal ischemia reperfusion injury in a hypothermic traumatic shock swine model. METHODS SMA was completely clamped while pigs were hemorrhaged to a mean arterial pressure (MAP) of 40 mm Hg. Animals were then randomized into temporary ligation (A, n=8), primary anastomosis (B, n=8), temporary shunt (C, n=8), and control groups (n=4). Animals in group A remained SMA interrupted for additional 1h while the other groups underwent the corresponding procedures immediately. Intestine injury was assessed by histologic examination and measurement of lipid peroxidations at the end of ischemia and experiment. RESULTS Overall mortality rate was 50%, 25%, and 0% in groups A, B, and C, respectively (P<0.05). The total intestine ischemia time was predominantly shorter in group C in the other groups. Remarkable elevations of malonaldehyde (MDA) in small intestine were noted after reperfusion in group A. Animals in other groups, however, did not exacerbate during the 6-h reperfusion (resuscitation period). Group C showed the lowest MDA level at the end of experiment. Myeloperoxidase (MPO) levels showed no significant elevations during the ischemia or early reperfusion period; nevertheless, it reached approximately 3- to 6-fold in groups A and B (compared with baseline, P<0.01), and remained unchanged in group C at the end of experiment. CONCLUSION Our study suggests that temporary shunt insertion might be preferred as it shortens ischemia time, alleviates intestinal ischemia/reperfusion injury, and thus decreases early mortality in this animal model.
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Affiliation(s)
- Weiwei Ding
- Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Jiangsu Province, China
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Ding W, Wu X, Pascual JL, Zhao K, Ji W, Li N, Li J. Temporary intravascular shunting improves survival in a hypothermic traumatic shock swine model with superior mesenteric artery injuries. Surgery 2010; 147:79-88. [PMID: 19744445 DOI: 10.1016/j.surg.2009.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2008] [Accepted: 05/18/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND Repairs of superior mesenteric artery (SMA) injuries are difficult and often result in high mortality. Our group has employed temporary intravascular shunts (TIVS) as a damage control procedure in a SMA transection model and hypothesized that TIVS would improve survival when compared with primary vascular anastomosis in the setting of a damage control surgery. METHODS The SMA was clamped and completely transected while pigs were hemorrhaged to a mean arterial pressure of 40 mmHg and maintained in shock for 30 minutes. Cold lactated Ringer's solution was gradually infused while the abdomen was open to induce hypothermia. Animals were randomized to control (no resuscitation), primary anastomosis (PA), or temporary shunting (TS) of the SMA. Animals were resuscitated for 6 hours with the shed blood and lactated Ringer's solution. Delayed anastomosis was performed in TS animals after resuscitation. Surviving animals were humanely killed 2 days after operation. Systemic hemodynamic parameters were recorded hourly. The ileum was harvested at the end of resuscitation and experiment for pathologic evaluation. RESULTS All animals suffered extreme physiologic conditions: hypothermia, severe acidosis, hypotension, and depressed cardiac output and oxygen delivery. Control animals suffered 100% mortality. Compared with the PA group, TS animals required less resuscitation fluid, retained higher SMA flow rates, normalized lactate levels faster, suffered less severe intestine histopathology, and had greater early survival. CONCLUSION Damage control surgery in the setting of SMA transection seems better managed with TS than with PA. Further validation of this model is required before generalization to human applications.
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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] [What about the content of this article? (0)] [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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Narayanan G, Mohin G, Barbery K, Lamus D, Nanavati K, Yrizarry JM. Endovascular Management of Superior Mesenteric Artery Pseudoaneurysm and Fistula. Cardiovasc Intervent Radiol 2008; 31:1239-43. [DOI: 10.1007/s00270-008-9354-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Revised: 03/31/2008] [Accepted: 04/10/2008] [Indexed: 10/22/2022]
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Goffette PP. Imaging and Intervention in Post-traumatic Complications (Delayed Intervention). Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fabre A, Abita T, Lachachi F, Rudelli P, Carlier M, Bocquel JB, Remond A, Pech de Laclause B, Maisonnette F, Durand-Fontanier S, Valleix D, Descottes B, Reix T. [Inferior mesenteric arteriovenous fistulas. Report of a case]. ACTA ACUST UNITED AC 2005; 130:417-20. [PMID: 15982630 DOI: 10.1016/j.anchir.2005.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2004] [Accepted: 05/30/2005] [Indexed: 12/16/2022]
Abstract
We report a case of postoperative inferior mesenteric arteriovenous fistula. Arteriovenous fistula represents a rare disease. Symptoms are due to portal hypertension and distal ischemy. Treatment of these fistulas is embolization. Surgery is possible by ligature or excision of the fistula because vascularisation is obtained by Riolan arcade and hypogastric artery.
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Affiliation(s)
- A Fabre
- CHU Dupuytren, 2 avenue Martin-Luther-King, 87042 Limoges, France.
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Chiriano J, Abou-Zamzam AM, Teruya TH, Ballard JL. Delayed Development of a Traumatic Superior Mesenteric Arteriovenous Fistula Following Multiple Gunshot Wounds to the Abdomen. Ann Vasc Surg 2005; 19:470-3. [PMID: 15981124 DOI: 10.1007/s10016-005-4654-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Traumatic visceral arteriovenous fistulae are rare and pose a diagnostic and therapeutic challenge. We present the case of a 20-year-old male who sustained multiple gunshot wounds to the abdomen, injuring the inferior vena cava, duodenum, stomach, and small bowel. The patient was taken emergently to the operating room for repair of his injuries, which required primary small bowel repair, duodenal repair, and inferior vena cava ligation due to exigent hemorrhage. At the initial operation there was a normal pulse in the superior mesenteric artery at the base of the small bowel mesentery, with no evidence of hematoma or thrill in the small bowel mesentery. The patient was subsequently returned to the operating room several times for bowel exploration and abdominal wall closure with mesh. Ten days after his initial injury, the patient was noted to have an abdominal bruit on physical exam. Arteriography demonstrated a fistula between the proximal superior mesenteric artery and vein with significant portal hypertension. The patient underwent surgical repair of the superior mesenteric artery and vein with closure of the fistula. The patient had no further complications and was discharged from the hospital 1 month later, after abdominal wall skin grafting, in good condition. The patient remains in good health 12 months later. Continued vigilance and careful physical examination are important in the identification of delayed vascular injuries and allow timely treatment and avoidance of untoward long-term sequelae.
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Affiliation(s)
- J Chiriano
- Division of Vascular Surgery, Department of General Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
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Schwab CW, McMahon DJ, Phillips G, Pentecost MJ. Aortic balloon control of a traumatic aortoenteric fistula after damage control laparotomy: a case report. J Trauma 1996; 40:1021-3. [PMID: 8656457 DOI: 10.1097/00005373-199606000-00029] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Aortoenteric fistula is a rare complication of abdominal trauma. We present a case of a patient with multiple gunshot wounds to the abdomen and thorax in whom control of injury required staged operations. An aortoenteric fistula developed, presenting a diagnostic and therapeutic challenge. The operative control of aortic bleeding was by a retroperitoneal approach to the aorta and facilitated by the use of percutaneous aortic balloon catheters. The patient survived to leave hospital. This case highlights a rare trauma complication, the use of "damage control" for the severely injured abdomen and the technique of intra-arterial balloon control of bleeding from inaccessible locations.
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Affiliation(s)
- C W Schwab
- Division of Traumatology and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
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