Unusual arteriovenous communications: arteriographic and hemodynamic studies

Advances in diagnostics and successful repair of proximal posttraumatic superior mesenteric arteriovenous fistula

Posttraumatic arteriovenous fistulas affecting the superior mesenteric artery and vein are extremely rare. Twenty-four cases of posttraumatic superior mesenteric arteriovenous fistulas (SMAVFs) have been reported. We presented two cases of SMAVFs occurring in a young woman and man secondary to a gunshot and a grenade shrapnel wound in the epigastrium, respectively. Nausea, heartburn, emesis, and cramping abdominal pain were the clinical signs of SMAVF. Abdominal pains, particularly after meals, tense and meteoristic abdomen, frequent liquid bowel movements, oliguria, subfebrility, abdominal thrill, and bruit were also present. Abdominal duplex ultrasonic scanning and computed tomograms with a contrast agent were especially useful screening tools. As our results demonstrated, those methods were not only suitable for clinical use, but were also as good as arteriography in defining both the exact location and the extent of the mesenteric vessel involvement. However, the superior mesenteric arteriogram remains mandatory for complete preoperative evaluation. Arteriovenous fistulas were successfully treated by suturing the arterial and venous sides of the fistula in one case, and resectioning the fistula and end-to-end anastomosis in the other case.

Noninvasive assessment of arteriovenous fistula

Noninvasive diagnostic techniques permit objective assessment of the presence, location, and hemodynamic alterations associated with congenital or acquired arteriovenous fistulas. Doppler ultrasound may be used to assess abnormal velocity signals and directional blood flow in afferent and efferent limbs of the fistula, as well as abnormal pressure gradients in the involved extremity. Plethysmography permits graphic qualitative assessment of pulse wave form alterations before and after compression of the fistula. In addition, venous occlusion plethysmography permits quantitation of limb or digit blood flow before and after fistula. In addition, venous occlusion plethysmography permits quantitation of limb or digit blood flow before and after fistula compression. Illustrative cases of congenital and acquired arteriovenous fistulas demonstrate the utility of these noninvasive techniques in the objective assessment of patients.