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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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Satyam S, Kose S, Singh S, Prakash A, Garg A. Multidetector Computed Tomography Angiography Role in Diagnosing Superior Mesenteric Arteriovenous Fistula with Superior Mesenteric Vein Thrombosis: A Case Report. Euroasian J Hepatogastroenterol 2022; 12:98-101. [PMID: 36959984 PMCID: PMC10028700 DOI: 10.5005/jp-journals-10018-1380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Introduction Arteriovenous fistulas (AVF) of the superior mesenteric vasculature are rare vascular abnormalities. It often occurs due to iatrogenic injuries during bowel resection or abdominal traumas. As the patient exhibits a variety of signs and symptoms and can present late, diagnosis may be difficult.Multidetector computed tomography (MDCT) is the most common modality for imaging the small bowel, vessels, and mesentery in patients with mesenteric ischemia. Case presentation We present the case of a 25-year-old man who presented with features of acute intestinal obstruction and was operated on in an emergency. Resection of gangrenous small bowel and bowel adhesiolysis with double barrel ileostomy was performed. During exploratory laparotomy, gangrenous bowels were found, but no cause of mesenteric ischemia could be delineated. Finally, on computed tomography angiography (CTA) superior mesenteric arteriovenous fistula (SMAVF) with superior mesenteric vein (SMV) thrombosis was diagnosed. The patient was advised of aggressive anticoagulant therapy. Conclusion Computed tomography angiography has become the most reliable diagnostic modality to confirm the diagnosis and guide the best treatment strategy. How to cite this article Satyam S, Kose S, Singh S, et al. Multidetector Computed Tomography Angiography Role in Diagnosing Superior Mesenteric Arteriovenous Fistula with Superior Mesenteric Vein Thrombosis: A Case Report. Euroasian J Hepato-Gastroenterol 2022;12(2):98-101.
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Affiliation(s)
- Satyam Satyam
- Department of Radiodiagnosis, Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India
| | - Snehal Kose
- Department of Radiodiagnosis, Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India
| | - Sapna Singh
- Department of Radiodiagnosis, Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India
| | - Anjali Prakash
- Department of Radiodiagnosis, Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India
| | - Anju Garg
- Department of Radiodiagnosis, Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India
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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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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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Asensio JA, Dabestani PJ, Miljkovic SS, Wenzl FA, Kessler JJ, Kalamchi LD, Kotaru TR, Agrawal DK. Traumatic penetrating arteriovenous fistulas: a collective review. Eur J Trauma Emerg Surg 2021; 48:775-789. [PMID: 33386864 DOI: 10.1007/s00068-020-01574-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/07/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Traumatic penetrating arteriovenous fistulas (AVFs) are very rare. The majority of these injuries occur secondary to penetrating trauma. Objectives of this study: review their incidence, clinical presentation, radiologic identification, management, complications and outcomes. METHODS A literature search was performed on MEDLINE Complete-Pubmed from 1829-2019. PRISMA guidelines were utilized. Of 305 potentially eligible articles, 201 articles were selected. INCLUSION CRITERIA patients age ≥ 18, articles with title and abstract in English, AVFs secondary to penetrating trauma, articles which specified vessels involved in AVFs, and those reporting complete information on patient presentation, diagnosis, imaging, surgical and/or endovascular surgical management, and outcomes of penetrating AVF's. EXCLUSION CRITERIA articles reporting blunt or iatrogenic AVFs, pediatric patients, fistulas used for dialysis and their complications, articles lacking complete information, cranial/spinal AVFs or cardiac AVFs, and duplicate articles. Mechanism of injury (MOI), diagnosis, involved vessels, management and outcomes of patients with AVFs secondary to penetrating trauma were recorded. RESULTS There were a total of 291 patients with AVFs secondary to penetrating injuries. Mechanism of injury (MOI): stab wounds (SW)-126 (43.3%), Gunshot wounds (GSW)-94 (32.3%), miscellaneous-35 (12%), mechanism unspecified-36 (12.4%). Anatomic area: neck-69 (23.7%) patients, thorax-46 (15.8%), abdomen-87 (30%), upper and lower extremities-89 (30.6%). Most commonly involved vessels-vertebral artery-38 (13%), popliteal vein-32 (11.7%). Angiography was diagnostic-265 patients (91.1%). INTERVENTIONS Surgical- 202 (59.6%), Endovascular-118 (34.8%). Associated: aneurysms/pseudoaneurysms-129 (44.3%). CONCLUSION Most AVFs occur secondary to penetrating injuries. Stab wounds account for the majority of these injuries. Most frequently injured vessels are vertebral artery and superficial femoral vein. Surgical interventions are the most common mode of management followed by endovascular surgical techniques.
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Affiliation(s)
- Juan A Asensio
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA.
| | - Parinaz J Dabestani
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - Stephanie S Miljkovic
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - Florian A Wenzl
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - John J Kessler
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - Louay D Kalamchi
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - Tharun R Kotaru
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - Devendra K Agrawal
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, 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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