Iatrogenic superior mesenteric arteriovenous fistula: Ultrasonographic, CT and angiographic features and histological findings of the liver biopsy

Iatrogenic superior mesenteric arteriovenous fistula is rare. We treated a patient with this problem 6 years after small bowel resection for intestinal obstruction. The symptoms and signs were those of intestinal ischaemia and portal hypertension with an abdominal bruit. Ultrasonography and enhanced computerized tomography of the abdomen suggested the presence of superior mesenteric arteriovenous fistula, with a dilated portal vein and a communication between the dilated superior mesenteric vein and its artery. The exact location of the fistula was then determined by selective superior mesenteric arteriography. The fistula was ligated in an emergency operation to prevent cardiac or renal failure and to relieve portal hypertension. Liver biopsy showed no cirrhotic changes, but fibrosis was seen around the portal veins. We describe here not only the diagnostic arteriographic findings of superior mesenteric arteriovenous fistula, but also the interesting and suggestive ultrasonographic and computed tomographic findings. Early correction of such fistulas is recommended to prevent cardiac or liver failure.     

Ischemic colitis secondary to inferior mesenteric arteriovenous fistula and portal vein stenosis in a liver transplant recipient

Arteriovenous fistula （AVF） involving the inferior mesenteric vessels is rare, and the affected patients usually present with abdominal pain, mass, or features of established portal hypertension. Colonic ischemia is a less common and more serious manifestation of AVE We report a case of ischemic colitis secondary to inferior mesentedc AVF in a patient who underwent a previous liver transplantation, subsequently developed portal vein stenosis, and then presented with acute lower gastrointestinal bleeding. He underwent percutaneous transhepatic placement of a portal vein stent and left colectomy.     

Ischemic Colitis: An Unusual Case of Inferior Mesenteric Arteriovenous Fistula Causing Venous Hypertension. Report of a Case

Mesenteric arteriovenous fistulas are a rare entity. Those involving the inferior mesenteric artery are exceptionally rare with only 13 cases reported in the English literature,1,2 of which only one has been associated with ischemic colitis. Ischemic colitis is a well-recognized clinical entity that typically occurs spontaneously in elderly patients and is not associated with a specific clinical presentation.3 We report a case of ischemic colitis caused by venous hypertension associated with a congenital inferior mesenteric arteriovenous fistula. To our knowledge, this is the first reported case of a mesenteric arteriovenous fistula causing ischemic colitis in a patient without previous gastrointestinal surgery or trauma. Reprints are not available.     

Portal Hypertension Secondary to a Spontaneous Splenic Arteriovenous Fistula: Case Report and Review of the Literature

A 66-yr-old woman developed diarrhea, abdominal pain, and ascites which was subsequently discovered to be secondary to portal hypertension resulting from a splenic arteriovenous fistula. Splenectomy resulted in reduction of the portal pressure and resolution of the patient's symptoms. The literature pertaining to splenic arteriovenous fistulas with portal hypertension is discussed.     

Colorectal variceal bleeding in patients with extrahepatic portal vein thrombosis and idiopathic portal hypertension.

We report three patients with colonic variceal bleeding secondary to portal hypertension, 0.5% of all cases with hemorrhagic portal hypertension studied by us in the last 16 years. One patient had idiopathic portal hypertension, and the others had extrahepatic portal vein thrombosis. Colonic varices were documented in all three cases by angiogram; large arteriovenous fistulas in the territory of the superior mesenteric artery and between the inferior mesenteric artery and hemorrhoidal veins were demonstrated in one patient. Two patients underwent colonoscopy; colonic varices were seen in only one. Two patients also had bled from esophagogastric varices. One patient underwent descending colon and sigmoid resection after failure to control bleeding with ligation of arterial supply; one patient underwent the Sugiura procedure, plus transanal ligation of hemorrhoids and rectal varices. At 3 months, 2 years, and 4 years of follow-up, the patients were in good general condition without any evidence of rebleeding.     

Inferior mesenteric arteriovenous fistula associated with portal hypertension and acute ischemic colitis. Successful occlusion by intraarterial embolization with steel coils

The authors report a case of postoperative arteriovenous fistula between the inferior mesenteric vessels. This fistula was revealed by portal hypertension, with bleeding esophageal varices, ascites, and encephalopathy, and by acute ischemic colitis. Histologic examination of the liver was normal. All of the symptoms disappeared after transcatheter embolization of the fistula with stainless steel coils. This case report favors the reality of the so-called "forward" portal hypertension and suggests that inferior mesenteric arteriovenous fistula might be a factor predisposing to nonocclusive ischemic colitis.     

Inferior mesenteric arteriovenous fistula eight years after sigmoidectomy

We report a 69-year-old woman with liver cirrhosis due to chronic hepatitis C virus (HCV) infection in whom iatrogenic arteriovenous fistula (AVF) developed after sigmoidectomy. A soft mass with bruit led to the diagnosis of inferior mesenteric AVF. Most mesenteric AVF cases have portal hypertension, but this patients showed none of the usual symptoms of portal hypertension; however, she had a splenomegaly that became worse after sigmoidectomy. Clinicians should be aware of the possibility of AVF in patients with a history of abdominal surgery.     

Transcatheter embolization of an inferior mesenteric arteriovenous fistula with frequent mucous diarrhea]

We report a case of inferior mesenteric arteriovenous fistula without portal hypertension or mesenteric ischemia. A 64-year-old man had developed frequent mucous diarrhea during the previous month. Colonoscopy showed highly edematous mucosa of the rectum. Barium enema demonstrated localized stricture of the same part but no evidence of malignancy. Finally we established a diagnosis by 3D-CT and selective abdominal angiography. Transcatheter arterial embolization was successfully performed. After that, his symptoms gradually improved as all abnormal findings on colonoscopy, barium enema and abdominal CT disappeared.     

A case of recurrent infection caused by a pancreaticoduodenal fistula associated with a pancreatic arteriovenous malformation

Although arteriovenous malformations (AVM) occur frequently in digestive organs, pancreatic AVM is rare. The clinical symptoms of pancreatic AVM are variable and include gastrointestinal bleeding, abdominal pain, jaundice, portal hypertension, pancreatitis, and duodenal ulcer. However, choledochoduodenal or pancreaticoduodenal fistulas complicated with ascending infection and pancreatitis is extremely rare. Herein, we report a case of pancreaticoduodenal fistula associated with a pancreatic AVM that induced recurrent anemia and ascending infection.     

Spontaneous idiopathic subclavian arteriovenous fistula: a case report.

Systemic arteriovenous (AV) fistulas are a rare but correctable cause of hyperkinetic circulation and congestive heart failure. They are generally due to catheterization procedures, surgery, trauma, or aneurysms. A case of truly spontaneous AV fistula between left subclavian artery and left innominate vein is described. This patient presented with symptoms that might clinically be mistaken for a carpal tunnel syndrome. The discovery of a continuous to-and-fro murmur on her left upper sternal border led to the correct diagnosis. Surgical ligature of the fistula provided complete relief of the woman's symptoms.     

Colonic varices as a complication of colonic surgery

Colonic varices are a rare cause of lower gastrointestinal bleeding, with approximately 40 cases reported in the literature. Portal hypertension is by far the most common cause of colonic varices, with local mesenteric vein obstruction constituting a very rare cause. We present a case of colonic varices not associated with portal hypertension but secondary to prior sigmoid resection and inferior mesenteric vein occlusion.     

Unusual case of pulmonary hypertension

Truly reversible pulmonary hypertension is rare. Acquired systemic arteriovenous (A-V) fistulas following spinal surgery (laminectomy) are a less recognized cause of secondary pulmonary hypertension. We describe a patient who presented with symptoms and clinical evidence of pulmonary hypertension and underwent endovascular correction of an acquired A-V fistula, which led to improvement according to clinical and noninvasive hemodynamic criteria.     

Multiple aortocaval fistulas associated with a ruptured abdominal aneurysm in a patient with Ehlers-Danlos syndrome.

Aortocaval fistula (ACF) is a rare complication of spontaneous abdominal aortic aneurysm (AAA) rupture, with an incidence of 2-4%. A unique case of ruptured AAA complicated by multiple aortovenous fistulas involving the inferior vena cava and left internal iliac vein is presented, and is the first published report of a patient with Ehlers-Danlos syndrome undergoing surgical treatment for an ACF.     

Gastrointestinal bleeding caused by extrahepatic arterioportal fistula associated with portal vein thrombosis

An extrahepatic arterioportal fistula (APF) involving the gastroduodenal artery and superior mesenteric vein is rare and mostly results from iatrogenic injuries. The clinical symptoms associated with APFs may include abdominal pain, gastrointestinal bleeding, ascites, nausea, vomiting, diarrhea, or even congestive heart failure. We present the case of a 70-year-old man who presented with chronic abdominal pain and gastrointestinal bleeding secondary to APF and portal vein thrombosis. The endovascular embolization of APF was accomplished successfully, and symptoms of portal hypertension resolved immediately after intervention. Unfortunately, the patient did not respond well to anticoagulation therapy with warfarin. Therefore, the patient underwent implantation of a transjugular intrahepatic portosystemic shunt, and the complications of portal hypertension resolved. In conclusion, the embolization of APF is technically feasible and effective and can be considered the first-choice therapy in selected patients.     

Rectal arterio-portal fistula: An unusual cause of persistent bleeding per rectum following a proximal spleno-renal shunt

Gastrointestinal arterio-venous malformations are a known cause of gastrointestinal bleeding. We present a rare case of persistent rectal bleeding due to a rectal arterio-portal venous fistula in the setting of portal hypertension secondary to portal vein thrombosis. The portal hypertension was initially surgically treated with splenectomy and a proximal splenorenal shunt. However, rectal bleeding persisted even after surgery, presenting us with a diagnostic dilemma. The patient was re-evaluated with a computed tomography mesenteric angiogram which revealed a rectal arterio-portal fistula. Arterio-portal fistulas are a known but rare cause of portal hypertension, and possibly the underlying cause of continued rectal bleeding in this case. This was successfully treated using angiographic localizationand super-selective embolization of the rectal arterioportal venous fistula via the right internal iliac artery. The patient subsequently went on to have a full term pregnancy. Through this case report, we hope to high-light awareness of this unusual condition, discuss the diagnostic workup and our management approach.     

Endovascular Repair of Iatrogenic Superior Mesenteric Arteriovenous Fistula

Arteriovenous fistulas between the superior mesenteric artery and vein are extremely rare and often a late complication of bowel resection. We report a case of a 42-year-old male, who presented with abdominal pain and dyspnoea 9 years after ileo-caecal resection. A superior mesenteric arteriovenous fistula was detected and treated endovascularly with an Amplatzer Vascular Plug, thereby reducing the cardiac output and flow in the superficial mesenteric artery by 1.1 l min^?1. The patient had an uneventful recovery.     

Arteriovenous fistulas after median sternotomy--report of 2 cases and review of the literature

We report 2 cases of arteriovenous fistulas as a very rare complication following median sternotomy. In the first case a fistula was observed between the right internal mammary artery and vein caused by a sternal wire. The second patient developed a fistula between the innominate artery and left innominate vein after suture repair of a slight hemorrhage from the innominate vein. The latter localization has not been previously described. In both cases the fistulas were discovered by a continuous murmur appearing 12 and 11 days postoperatively. The therapy consisted of resternotomy and resection of the fistulas. The literature is reviewed and etiology, diagnosis and therapy are discussed.     

Unusual case of digestive hemorrhage: Celiac axis-portal vein arteriovenous fistula

A case of intractable upper gastrointestinal-hemorrhage was reported in a patient with portal hypertension caused by an arterioportal fistula(APF), namely, celiac axis-portal vein arteriovenous fistula. Portal hypertension caused by extrahepatic-APFs is extremely rare. Trauma, malignancy, and hereditary causes are the common etiology of APFs; but were absent in our patient. Our patient represents an unusualcase of unexplained APF who presented with portal hypertension and was successfully managed through endovascular aortic repair.     

Iatrogenic left subclavian artery-to-left brachiocephalic vein fistula: successful repair without a sternotomy

Subclavian vein catheterization can result in arteriovenous fistula formation--a rare complication that will eventually lead to heart failure if left untreated. The world medical literature describes several subclavian artery-to-subclavian vein fistulas and 2 subclavian artery-to-brachiocephalic vein fistulas, both on the right side. To our knowledge, there have been no reports of an iatrogenic left subclavian artery-to-left brachiocephalic vein fistula. We report a case in which this complication occurred after unsuccessful transvenous pacemaker placement. We treated the fistula with a simple surgical technique that avoided the need for a sternotomy. Although stenting is typically the procedure of choice for such fistulas, our technique is useful when stenting is not indicated.     

A case of bilateral coronary artery to pulmonary artery fistulas associated with hepatic arteriovenous fistula

A 55-year-old man, previously treated for primary hypothyroidism, was admitted for evaluation of atypical chest pain. On physical examination, the pulse rate was 60 and blood pressure was 132/84 mmHg. Heart sounds were normal and no murmur was heard. Abdominal palpation showed no abnormal finding, and bruit was not heard. The electrocardiogram was normal and stress-induced ischemia was not found. The chest X-ray showed no sign of pulmonary hyperaemia or mass lesion, and central shadow was normal (CTR = 44%). During right heart catheterization, the pressures were normal in the cardiac chambers, pulmonary artery, and wedge position. A significant increase in oxygen saturation was disclosed at pulmonary artery level (10%) and the upper site of the inferior vena cava (22%). Coronary arteriography found coronary artery fistulas from the left main trunk, the left anterior descending artery, the left circumflex, and the right coronary artery to the pulmonary trunk. The left and right ventriculograms were normal. The digital subtraction angiography of celiac artery showed hepatic arteriovenous fistula. Ultrasonography and computed tomography found no mass lesion of the liver. Since combination of the bilateral coronary artery with pulmonary artery fistula, and hepatic arteriovenous fistula is very rare, the present case is worth noting for the investigation of the pathogenesis of congenital arteriovenous fistulas.