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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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2
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Shah YB, Lee D, Khaddash TS. Endovascular approach in the management of idiopathic myointimal hyperplasia of the inferior mesenteric vein. CVIR Endovasc 2021; 4:88. [PMID: 34921664 PMCID: PMC8684567 DOI: 10.1186/s42155-021-00272-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background Idiopathic myointimal hyperplasia of the mesenteric vein (IMHMV) is a rare, often undiagnosed pathology affecting the colon. Patients typically present with severe abdominal pain and inflammation caused by smooth muscle proliferation of the veins, leading to arterialization, stenosis, and potential occlusion. The etiology remains unclear, but it has been hypothesized that an arteriovenous connection may be associated with the pathology. This is the first reported case indicating such an association. This case additionally highlights the potential utility of endovascular treatment, as endovascular embolization is generally a less invasive alternative to surgical resection in the treatment of such vascular disorders. Case Presentation This report describes a 24-year-old female patient with findings of colitis and an abnormal arteriovenous connection of the inferior mesenteric arterial and venous systems. Partial embolization of this arteriovenous connection temporarily improved the patient’s condition, but her symptoms ultimately returned due to the presence of multiple smaller feeder vessels not amenable to embolization, necessitating colonic resection for definitive treatment. Although prior reports have hypothesized that arterial pressurization of the veins may precipitate myointimal hyperplasia, to the authors’ knowledge, this is the first report of IMHMV with an associated abnormal arteriovenous connection. Conclusions This case illustrates the possibility of an association between an arteriovenous connection and IMHMV. This rare diagnosis should be considered in patients with a similar presentation of abdominal pain after common etiologies like IBD have been excluded.
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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] [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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Liu C, Wu H, Fu Z, Tang M, Ruan H, Zhang L. Superior mesenteric arteriovenous fistula presenting as diarrhea: a case report and literature review. Am J Transl Res 2021; 13:8172-8178. [PMID: 34377302 PMCID: PMC8340185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/25/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Superior mesenteric arteriovenous fistula (SMAVF) is a very rare disease and mainly manifests as abdominal pain, diarrhea, anorexia, and other portal hypertension symptoms. The diagnosis of the disease mainly relies on abdominal enhanced CT+3D reconstruction or digital subtraction angiography, and the treatment is mainly vascular interventional fistula occlusion. CASE SUMMARY a 17-year-old female with a history of abdominal trauma and surgery was admitted to our hospital for diarrhea and abdominal distension. The patient was diagnosed with a superior mesenteric arteriovenous fistula after abdominal enhanced CT + 3D reconstruction. The patient was satisfied with the results after the superior mesenteric artery angiography + covered stent implantation. No discomfort symptoms occurred during the two-year follow-up. CONCLUSION A history of abdominal trauma or surgery and clinical manifestations in combination with a radiological analysis are important indicators in the diagnosis of SMAVF. Interventional therapy is the preferred treatment.
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Affiliation(s)
- Changjiang Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan, China
| | - Haixia Wu
- Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan, China
| | - Zhongbiao Fu
- Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan, China
| | - Mingliang Tang
- Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan, China
| | - Hailan Ruan
- Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan, China
| | - Liyuan Zhang
- Department of Infectious Diseases, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan, 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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Nasra K, Heidenreich A, Nasra M, Wolf E, Lincoln D. Successful Coil Embolization Treatment of a Large Arterioportal Fistula: A Rare Cause of Mesenteric Ischemia. Cureus 2021; 13:e14322. [PMID: 33968532 PMCID: PMC8101531 DOI: 10.7759/cureus.14322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Superior mesenteric arteriovenous fistulae (SMAVF) are a rare complication from trauma or iatrogenic surgical intervention. There are less than 50 cases reported in the literature and no clear guidelines as to the best practices for diagnosis and treatment. SMAVF are often asymptomatic but can present with nonspecific abdominal symptoms ranging from nausea and vomiting to gastrointestinal bleeding and mesenteric ischemia. Symptom onset, when present, is often delayed years after the inciting event, further complicating the diagnosis. We present a case of a 71-year-old man presenting with mesenteric ischemic symptoms secondary to a large SMAVF that was successfully treated with coil embolization. We describe our approach to treatment and describe the classical imaging findings. We, then, review the current literature and management recommendations.
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Affiliation(s)
- Karim Nasra
- Radiology, Ascension Providence/Michigan State University, Southfield, USA
| | - Alicia Heidenreich
- Radiology, Ascension Providence/Michigan State University, Southfield, USA
| | - Matthew Nasra
- Radiology, Robert Wood Johnson University Hospital, New Brunswick, USA
| | - Erik Wolf
- Radiology, Ascension Providence/Michigan State University, Southfield, USA
| | - Denis Lincoln
- Radiology, Ascension Providence/Michigan State University, Southfield, USA
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Jargiełło T, Sobstyl J, Kasztelan-Szcerbinska B, Sojka M, Pyra K. Endovascular treatment of the superior mesenteric arteriovenous fistula complicated by gastrointestinal bleeding. TURKISH JOURNAL OF GASTROENTEROLOGY 2018; 30:652-654. [PMID: 30460904 DOI: 10.5152/tjg.2018.17744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Jan Sobstyl
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | | | - Michal Sojka
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
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Ji YF, Zhang XM, Mitchell DG, Li XH, Chen TW, Li Y, Bao ZG, Tang W, Xiao B, Huang XH, Yang L. Gastrointestinal tract involvement in acute pancreatitis: initial findings and follow-up by magnetic resonance imaging. Quant Imaging Med Surg 2017; 7:641-653. [PMID: 29312869 DOI: 10.21037/qims.2017.12.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background To study the initial and follow up patterns of gastrointestinal tract involvement in acute pancreatitis (AP) using magnetic resonance imaging (MRI). Methods A total of 209 patients with AP undergoing abdominal MRI on 1.5 T MRI were compared to 100 control patients selected from our daily clinical caseload who underwent MRI over the same recruitment period and had no other disease which can cause abnormality of gastrointestinal tract. Initial and follow up MRI examinations of gastrointestinal tract abnormalities were noted for AP patients. The severity of AP was graded by the MRSI and APACHE II. Spearman correlation of gastrointestinal tract involvement with MRSI and APACHE II was analyzed. Results In 209 patients with AP, 63% of the AP patients on their initial MRI exams and 5% of control subjects had at least one gastrointestinal tract abnormality (P<0.05). In the control group, thirty-seven patients were normal on MRI, 24 patients with renal cysts, eighteen patients with liver cysts, eleven patients with liver hemangiomas, and ten patients with splenomegaly. The abnormalities of gastrointestinal tract observed in AP patients included thickened stomach wall (20%), thickened duodenum wall (27%), thickened ascending colon wall (11%), thickened transverse colon wall (15%), and thickened descending colon wall (26%), among others. Gastrointestinal tract abnormalities were correlated with the MRSI score (r=0.46, P<0.05) and APACHE II score (r=0.19, P<0.05). Among 62 patients who had follow up examinations, 26% of patients had gastrointestinal tract abnormality, which was significantly lower than that in the initial exams (P<0.05). Resolution of gastrointestinal tract abnormal MRI findings coincided with symptom alleviation in AP patients. Conclusions Gastrointestinal tract abnormalities on MRI are common in AP and they are positively correlated with the severity of AP. It may add value for determining the severity of AP.
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Affiliation(s)
- Yi-Fan Ji
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Xiao-Ming Zhang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Don G Mitchell
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Xing-Hui Li
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Tian-Wu Chen
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Yong Li
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Zhi-Guo Bao
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Wei Tang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Bo Xiao
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Xiao-Hua Huang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Lin Yang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
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Grujić D, Knežević A, Vojvodić S, Grujić B. Superior Mesenteric Arteriovenous Fistula Presenting with Massive Lethal Upper Gastrointestinal Bleeding 14 Years after Small Bowel Resection. Balkan Med J 2015; 32:214-7. [PMID: 26167348 DOI: 10.5152/balkanmedj.2015.15608] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 01/04/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Arteriovenous fistulas (AVFs) of the superior mesenteric vasculature are rarely encountered. We present a case of an iatrogenic superior mesenteric AVF in a patient who had undergone a small bowel resection 14 years previously. CASE REPORT The 45-year-old male was admitted with bloody diarrhea, fatigue, weight loss and moderate ascites. On the fifth hospital day, while being evaluated for suspected liver cirrhosis, the patient developed severe gastrointestinal (GI) bleeding. An upper GI endoscopy revealed bleeding, esophago-gastric varices. A thorough clinical examination pointed to a paraumbilical murmur and thrill, while a contrast enhanced computerized tomography (CT) scan of the abdomen revealed the presence of cystic dilatation of the superior mesenteric vein (SMV), hepatomegaly and ascites. Duplex ultrasonography and 3D-computed tomography angiography (3D-CTA) confirmed the existence of AVF between the superior mesenteric artery (SMA) and SMV, which was the cause of portal hypertension and variceal bleeding. Despite the fact that AVF was ultimately recognized, uncontrollable hypovolemic shock caused by hematemesis, precluded the probable efficiency of further therapeutic attempts. CONCLUSION Successful management of mesenteric blood vessel AVFs involves timely and the accurate diagnosis and early treatment in order to prevent the development of life threatening complications.
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Affiliation(s)
- Dušan Grujić
- Department of Internal Medicine, Emergency Center, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Aleksandar Knežević
- Department of Internal Medicine, Emergency Center, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Svetlana Vojvodić
- Department of Laboratory Diagnostics, Institute for Blood Transfusion of Vojvodina, University of Novi Sad Faculty of Medicine, Novi Sad, Serbia
| | - Bojana Grujić
- Department of Anesthesia and Intensive Therapy, Emergency Center, Clinical Center of Vojvodina, Novi Sad, Serbia
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Qin J, Tang S, Jiang M, He Q, Zhou J, Yao X, Zeng W, Liang Y, Gu M. Portal hypertension caused by right common iliac artery-superior mesenteric vein fistula. Jpn J Radiol 2015; 33:291-4. [PMID: 25753263 DOI: 10.1007/s11604-015-0411-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 03/02/2015] [Indexed: 12/18/2022]
Abstract
Portal hypertension caused by arterio-portal fistula between the right common iliac artery and superior mesenteric vein has not been reported. Here, we report such a case in a 35-year-old male without any history of liver disease or abdominal trauma. This case was confirmed by abdominal aorta angiography and three-dimensional angiography, and was successfully treated by a covered stent implantation in the right common iliac artery to block the fistula.
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Affiliation(s)
- Jianping Qin
- Department of Digestion, General Hospital of Chengdu Military Command, 270 Tianhui Rd, Chengdu, 610083, Sichuan, China,
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Nasrullah A, Bell JK, Reddy S, Ashleigh R, Rudralingam V. Looking beyond lymph nodes: Beware of the lurking pseudoaneurysm! GASTROINTESTINAL INTERVENTION 2014. [DOI: 10.1016/j.gii.2014.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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