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Endovascular Occlusion of Giant Posttraumatic Pseudo-Aneurysm of Superior Mesenteric Artery Connected to Mesenteric Arteriovenous Fistula

Endovascular Occlusion of Giant Posttraumatic Pseudo-Aneurysm of Superior Mesenteric Artery Connected to Mesenteric Arteriovenous Fistula

Dzhagraev K.R., Muslimov R.Sh., Klimov A.B., Ryabukhin V.E., Kim T.E., Selina I.E., Kiryushchenkov V.P., Moskalenko V.A., Kokov L.S.
Key words: giant pseudo-aneurysm of superior mesenteric artery; traumatic mesenteric arteriovenous fistula; Amplatzer Vascular Plug II occluder; endovascular occlusion of mesenteric arteriovenous fistula.
2020, volume 12, issue 4, page 55.

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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.

Materials and Methods. A 27-old male patient underwent endovascular occlusion; the patient being hospitalized with a clinical picture of gastrointestinal bleeding. The examinations: ultrasound, esophagogastroduodenoscopy, multispiral computed tomography with angiography — revealed the source of bleeding to be esophageal varices against the background of portal hypertension caused by massive arteriovenous shunt, its source being AVF with an aneurysmal component (32×35 mm in size) between SMA and superior mesenteric vein (SMV) dilated up to 50 mm in diameter. Patient’s past medical history recorded that 4.5 years ago the patient had undergone the resection of a small intestine area due to a penetrating stab wound in the abdominal cavity. Taking into consideration an extremely high operative intervention risk due to the condition severity related to blood loss, portal hypertension, and ascites, it was decided to embolize AVF with a vascular occluder — Amplatzer Vascular Plug II (USA), 14×10 mm in size.

Results. A unique endovascular intervention — transcatheter occlusion of pseudo-aneurysm and AVF separation — was performed in life-threatening esophageal variceal bleeding under the condition of a giant post-traumatic aneurysm of SMA and mesenteric AVF. Due to an extremely large-sized SMV and an arterial pseudo-aneurysm, first ever we used the technique applied for transcatheter occlusion of a cardiac septum defect.

Occluder implantation enabled to completely close the communication of aneurysmatic AVF with SMV, and occlude the aneurysm cavity. During an immediate postoperative period portal hypertension was arrested. No recurrent bleedings occurred within 4 postoperative months.

  1. Van Way C.W. 3rd, Crane J.M., Riddell D.H., Foster J.H. Arteriovenous fistula in the portal circulation. Surgery 1971; 70(6): 876–890.
  2. Brucher N., Moskovitch G., Otal P., Chaufour X., Rousseau H. Inferior mesenteric arteriovenous fistula treated by percutaneous arterial embolization: a breathtaking story! Diagn Interv Imaging 2014; 95(1): 85–86, https://doi.org/10.1016/j.DIII.2013.09.004.
  3. Karyakin A.M., Ivanov M.A. Mesenteric arteriovenous fistula with the formation of aneurysm and portal hypertension. Vestnik hirurgii im. I.I. Grekova 1999; 6: 87–89.
  4. Kollmeyer K.R., Hunt J.L., Ellman B.A., Fry W.J. Acute and chronic traumatic arteriovenous fistulae in civilians. Epidemiology and treatment. Arch Surg 1981; 116(5): 697–702, https://doi.org/10.1001/archsurg.1981.01380170169030.
  5. Protopopov A.V., Kochkina T.A., Kokov L.S., Gavrikov P.G., Derevyankin Yu.S., Likhosherst E.E. Renal artery replacement for arteriovenous traumatic fistula. Angiologia i sosudistaa hirurgia 2002; 8(3): 121–125.
  6. François F., Thévenet A. Superior mesenteric arteriovenous fistula after ileal resection. Ann Vasc Surg 1992; 6(4): 370–372, https://doi.org/10.1007/BF02008795.
  7. Saunders M.S., Riberi A., Massullo E.A. Delayed traumatic superior mesenteric arteriovenous fistula after a stab wound: case report. J Trauma 1992; 32(1): 101–106, https://doi.org/10.1097/00005373-199201000-00021.
  8. Radonić V., Barić D., Petricević A., Koplić S., Giunio L., Radonić S. Advances in diagnostics and successful repair of proximal posttraumatic superior mesenteric arteriovenous fistula. J Trauma 1995; 38(2): 305–312, https://doi.org/10.1097/00005373-199502000-00032.
  9. 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(2): 214–217, https://doi.org/10.5152/balkanmedj.2015.15608.
  10. Stepanova Yu.A., Karmazanovsky G.G., Kokov L., Kriger A.G., Tsygankov V.N. False aneurisms of visceral arteries: radiology methods in diagnostics and treatment. HPB (Oxford) 2016; 18(Suppl 1): e447, https://doi.org/10.1016/j.hpb.2016.03.175.
  11. Kokov L.S., Pokrovskiy A.V., Tarbaev V.N., Shubin A.A., Sitnikov A.V., Tarbaeva N.V. Combined treatment of post-traumatic arteriovenous aneurysm between the aorta and the left renal vein. Angiologia i sosudistaa hirurgia 2007; 13(2): 121–124.
  12. Wang C., Zhu X., Guo G.H., Shu X., Wang J., Zhu Y., Li B., Wang Y. Superior mesenteric arteriovenous fistula presenting as gastrointestinal bleeding: case report and literature review. Rev Esp Enferm Dig 2016; 108(8): 503–507, https://doi.org/10.17235/reed.2015.3852/2015.
  13. Wu C.G., Li Y.D., Li M.H. Post-traumatic superior mesenteric arteriovenous fistula: endovascular treatment with a covered stent. J Vasc Surg 2008; 47(3): 654–656, https://doi.org/10.1016/j.jvs.2007.10.013.
  14. Temin N.N., Flacke S., Ahari H.K. Superior mesenteric arteriovenous fistula: imaging findings and endovascular treatment. Vasc Endovascular Surg 2012; 46(8): 675–678, https://doi.org/10.1177/1538574412465481.
  15. Hirakawa M., Nishie A., Asayama Y., Ishigami K., Ushijima Y., Fujita N., Honda H. Clinical outcomes of symptomatic arterioportal fistulas after transcatheter arterial embolization. World J Radiol 2013; 5(2): 33–40, https://doi.org/10.4329/wjr.v5.i2.33.
  16. Shin F.C., Wang S.J., Dang K.J., Su C.J., Chan C.C., Tan K.H., Shaw K.Y. Succesful management of traumatic mesenteric arteriovenous fistula after failure of steel coil embolization: case report. J Trauma 1994; 37(4): 682–686, https://doi.org/10.1097/00005373-199410000-00026.
  17. Tuite D.J., Kessel D.O., Nicholson A.A., Patel J.V., McPherson S.J., Shaw D.R. Initial clinical experience using the Amplatzer vascular plug. Cardiovasc Intervent Radiol 2007; 30(4): 650–654, https://doi.org/10.1007/s00270-007-9044-3.
  18. Hussein M., Issa G., Muhsen S., Haydar A. Superior mesenteric arteriovenous fistula embolisation complicated by bowel ischaemia. BMJ Case Rep 2013; 2013: bcr2013009521, https://doi.org/10.1136/bcr-2013-009521.
  19. Kokov L.S., Tsygankov V.N., Khamnagadaev I.A., Akinfiev D.M. Endovascular occlusion of posttraumatic suprarenal aortic pseudoaneurysm. Angiologia i sosudistaa hirurgia 2011; 17(1): 137–140.
  20. Wang W., Li H., Tam M.D., Zhou D., Wang D.X., Spain J. The Amplatzer vascular plug: a review of the device and its clinical applications. Cardiovasc Intervent Radiol 2012; 35(4): 725–740, https://doi.org/10.1007/s00270-012-0387-z.
  21. Peynircioglu B., Cil B. Amplatzer stuffing technique in the treatment of an iatrogenic mesenteric arteriovenous fistula. Cardiovasc Intervent Radiol 2009; 32(6): 1247–1251, https://doi.org/10.1007/s00270-009-9614-7.
  22. Ward T.J., Marin M.L., Lookstein R.A. Embolization of a giant arterioportal fistula requiring multiple Amplatzer vascular plugs. J Vasc Surg 2015; 62(6): 1636–1639, https://doi.org/10.1016/j.jvs.2014.04.031.
  23. Roux P., Hébert Th., Anghelescu D., Kerneis J., Nonent M. Endovascular treatment of arterioportal fistula with the Amplatzer occlusion device. J Vasc Interv Radiol 2009; 20(5): 685–687, https://doi.org/10.1016/j.jvir.2009.02.012.
Dzhagraev K.R., Muslimov R.Sh., Klimov A.B., Ryabukhin V.E., Kim T.E., Selina I.E., Kiryushchenkov V.P., Moskalenko V.A., Kokov L.S. Endovascular Occlusion of Giant Posttraumatic Pseudo-Aneurysm of Superior Mesenteric Artery Connected to Mesenteric Arteriovenous Fistula. Sovremennye tehnologii v medicine 2020; 12(4): 55, https://doi.org/10.17691/stm2020.12.4.07


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