Successful transcatheter embolization of a superior mesenteric arteriovenous fistula: Comprehensive imaging assessment and 3-year follow-up

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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“…There is an association with connective tissue disease. The most common causes, however, are trauma and iatrogenic injury [4].…”

Section: Discussionmentioning

confidence: 99%

“…SMAVF are often asymptomatic, which may partially contribute to the low reported incidence. Symptom onset is often delayed and ranges in days to decades after the inciting event (if an inciting event is found) [3,4]. Symptoms are generally nonspecific at presentation.…”

Section: Discussionmentioning

confidence: 99%

Successful Coil Embolization Treatment of a Large Arterioportal Fistula: A Rare Cause of Mesenteric Ischemia

Nasra

Heidenreich

Nasra

et al. 2021

Cureus

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Transarterial embolization of secondary inferior and superior mesenteric artery arteriovenous fistulas: a systematic review

Ruge

Kumar

Jose

et al. 2022

Egypt J Radiol Nucl Med

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Background Acquired arteriovenous fistula are rare complications of a piercing injury, including a gunshot or knife injury, the rupture of a preexisting aneurysm into a neighboring vein, or a complication of arterial catheterization or abdominal surgical techniques, most often colonic resection. Our aim was to develop an online systematic review of the literature to determine all documented incidents of endovascular embolization of secondary mesenteric Arteriovenous Fistula, spanning key databases as well as pertinent publications, from 1982 to 2019. Our case was included as well. The primary objectives were technical success and death; the secondary outcomes were the frequency of complications and the advice of the operators. Main body Forty articles, comprising 41 patients, including our own, were reviewed. The superior mesenteric vessels are the most commonly affected by fistulas. Endovascularembolization was used in 80% of the cases. 100% of the patients had technical success. The intraoperative death rate was 0%, with a 90-day mortality rate of 8%, half of which was unrelated to the original pathology. More than 60% of patients who underwent successful treatments had no severe problems. All others had uneventful recoveries, with only 12% experiencing mild problems that were managed conservatively. Conclusions The majority of authors supported this therapeutic approach thereby making endovascular glue embolization the treatment of choice for superior mesenteric arteriovenous fistula and inferior mesenteric arteriovenous fistula in high risk patients and in patients with multiple co-morbidities.

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Unexpected Etiology of Ascites in Disseminated Small Bowel Neuroendocrine Tumor Patient Diagnosed and Treated by Interventional Radiological Techniques

Перегудов¹,

Sergeeva²,

Виршке³

et al. 2022

jour

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A case of ascites developed in disseminated neuroendocrine small bowel tumor G1 (Ki-67 2 %) patient due to the unlikeliest of the possible reasons, i.e. iatrogenic mesenteric arterioportal fistula, is presented in the paper. The patient after palliative small bowel resection was preparing for the liver transarterial chemoembolization (TACE) when the fluid accumulation was revealed in the peritoneal cavity at ultrasound and MR imaging. The probable ascites etiologies (peritoneal carcinomatosis, carcinoid right heart failure, portal hypertension due to tumor compression or vascular elastic fibrosis) were consistently ruled out. The fistulation between the superior mesenteric arterial branch and the superior mesenteric vein developed shot after small bowel surgery and maintaining portal ascites was occasionally found at superior mesentericography. The ascites vanished after fistula occlusion with the metal coils, and the patient proceeded to the planned liver TACE therapies with good effect.

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Successful transcatheter embolization of a superior mesenteric arteriovenous fistula: Comprehensive imaging assessment and 3-year follow-up

Cited by 3 publications

References 6 publications

Successful Coil Embolization Treatment of a Large Arterioportal Fistula: A Rare Cause of Mesenteric Ischemia

Successful Coil Embolization Treatment of a Large Arterioportal Fistula: A Rare Cause of Mesenteric Ischemia

Transarterial embolization of secondary inferior and superior mesenteric artery arteriovenous fistulas: a systematic review

Unexpected Etiology of Ascites in Disseminated Small Bowel Neuroendocrine Tumor Patient Diagnosed and Treated by Interventional Radiological Techniques

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