Treatment of superior mesenteric artery portal vein fistula with balloon-expandable stent graft.

Visceral artery to portal vein arteriovenous fistulas are rare and difficult to treat. Covered stents have made treatment of pseudoaneurysms and arteriovenous fistulas feasible utilizing minimally invasive techniques. We present a case of a 46-year-old male with a remote history of an exploratory laparotomy after a motorcycle accident who presented with abdominal pain, malaise, and jaundice. A computed tomographic scan revealed a superior mesenteric artery to portal vein arteriovenous fistula. A large arteriovenous fistula was confirmed by arteriography. A balloon-expandable stent graft was placed across the arteriovenous fistula in the superior mesenteric artery. Postprocedure, the patient's abdominal pain resolved and his bilirubin decreased from 2.9 to 0.4. Endovascular repair of a superior mesenteric to portal arteriovenous fistula utilizing a stent graft is feasible and minimally invasive.

Delayed development of a traumatic superior mesenteric arteriovenous fistula following multiple gunshot wounds to the abdomen.

Traumatic visceral arteriovenous fistulae are rare and pose a diagnostic and therapeutic challenge. We present the case of a 20-year-old male who sustained multiple gunshot wounds to the abdomen, injuring the inferior vena cava, duodenum, stomach, and small bowel. The patient was taken emergently to the operating room for repair of his injuries, which required primary small bowel repair, duodenal repair, and inferior vena cava ligation due to exigent hemorrhage. At the initial operation there was a normal pulse in the superior mesenteric artery at the base of the small bowel mesentery, with no evidence of hematoma or thrill in the small bowel mesentery. The patient was subsequently returned to the operating room several times for bowel exploration and abdominal wall closure with mesh. Ten days after his initial injury, the patient was noted to have an abdominal bruit on physical exam. Arteriography demonstrated a fistula between the proximal superior mesenteric artery and vein with significant portal hypertension. The patient underwent surgical repair of the superior mesenteric artery and vein with closure of the fistula. The patient had no further complications and was discharged from the hospital 1 month later, after abdominal wall skin grafting, in good condition. The patient remains in good health 12 months later. Continued vigilance and careful physical examination are important in the identification of delayed vascular injuries and allow timely treatment and avoidance of untoward long-term sequelae.

Inflammatory abdominal aortic aneurysm treated by endovascular stent grafting: a case report.

Despite complications inherent to open surgical repair of inflammatory abdominal aortic aneurysms, there is expected resolution of the retroperitoneal inflammatory process following graft replacement. An endovascular approach could also exclude the aneurysm while potentially avoiding injury to vital structures in the hostile operative field. However, data are limited regarding the role of endovascular stent grafts in the management of inflammatory abdominal aortic aneurysms. Furthermore, postoperative regression of perianeurysmal inflammation is rarely discussed in the few published accounts of endovascular repair of inflammatory aortic aneurysms. The case presented demonstrates successful endovascular treatment of an infrarenal inflammatory aneurysm with resolution of the retroperitoneal inflammation and hydronephrosis.