Shinagawa Austin, Billah Zaeem, Kansagra Kartik, Lam Cuong, Vatakencherry Geogy
Kaiser Permanente Los Angeles Medical Center, Vascular and Interventional Radiology, 4867 Sunset Boulevard, Los Angeles, CA, 90027, USA.
CVIR Endovasc. 2022 Jul 22;5(1):35. doi: 10.1186/s42155-022-00296-0.
Superior mesenteric arteriovenous fistula is a rare vascular anomaly often presenting with sequelae of portal hypertension, heart failure, or mesenteric ischemia. This report describes a patient with a previously unidentified superior mesenteric arteriovenous fistula who presented with variceal bleeding, thought to be the leading cause of mortality associated with this condition. Although this patient was initially referred for a transjugular intrahepatic portosystemic shunt procedure, following a thorough review of her clinical history and imaging, she instead underwent embolization of the arteriovenous fistula likely responsible for her symptoms.
A 75-year-old woman with a past surgical history of extensive small bowel resection presented with active variceal bleeding requiring transfusions. She was referred to vascular and interventional radiology for transjugular intrahepatic portosystemic shunt procedure; however, her clinical presentation was inconsistent with cirrhosis. This prompted a further review of her imaging, which identified a superior mesenteric arteriovenous fistula as the probable etiology of her varices. This fistula was subsequently embolized with a vascular plug and follow-up upper endoscopy at 1-month demonstrated complete resolution of her varices.
This report highlights a potential etiology of variceal bleeding in the acutely ill patient. Through a thorough consultation, the patient described here was able to avoid a procedure with the potential to cause catastrophic consequences, and instead receive the appropriate treatment for an uncommon condition.
Level 4, Case Report.
肠系膜上动静脉瘘是一种罕见的血管异常，常表现为门静脉高压、心力衰竭或肠系膜缺血的后遗症。本报告描述了一名患有先前未确诊的肠系膜上动静脉瘘的患者，该患者出现静脉曲张出血，被认为是与该疾病相关的主要死亡原因。尽管这名患者最初因经颈静脉肝内门体分流术前来就诊，但在对其临床病史和影像学进行全面评估后，她接受了可能导致其症状的动静脉瘘栓塞治疗。
一名75岁女性，既往有广泛小肠切除术的手术史，出现活动性静脉曲张出血，需要输血。她被转诊至血管与介入放射科进行经颈静脉肝内门体分流术；然而，她的临床表现与肝硬化不符。这促使对她的影像学进行进一步评估，结果发现肠系膜上动静脉瘘可能是其静脉曲张的病因。随后用血管封堵器对该瘘进行了栓塞治疗，1个月后的随访上消化道内镜检查显示其静脉曲张完全消退。
本报告强调了急性病患者静脉曲张出血的一种潜在病因。通过全面会诊，此处描述的患者得以避免可能导致灾难性后果的手术，转而接受针对罕见疾病的适当治疗。
4级，病例报告。
