Spontaneous inferior mesenteric arteriovenous fistula as a cause of severe portal hypertension and cardiomyopathy

Jaideep Das Gupta; Muhammad A Rana; Adam Delu; Sundeep Guliani; Mark Langsfeld; John Marek

doi:10.1016/j.jvscit.2018.11.007

Spontaneous inferior mesenteric arteriovenous fistula as a cause of severe portal hypertension and cardiomyopathy

J Vasc Surg Cases Innov Tech. 2019 Apr 28;5(2):113-116. doi: 10.1016/j.jvscit.2018.11.007. eCollection 2019 Jun.

Authors

Jaideep Das Gupta¹, Muhammad A Rana^{1

2}, Adam Delu³, Sundeep Guliani^{1

2}, Mark Langsfeld^{1

2}, John Marek^{1

2}

Affiliations

¹ Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM.
² Division of Vascular Surgery, University of New Mexico School of Medicine, Albuquerque, NM.
³ Department of Radiology, University of New Mexico School of Medicine, Albuquerque, NM.

Abstract

Inferior mesenteric artery (IMA) and inferior mesenteric vein (IMV) fistulas or malformations are extremely rare, with only 36 cases reported. Low incidence and nonspecific clinical signs and symptoms make mesenteric arteriovenous fistulas difficult to diagnose. We describe a case of a primary IMA-IMV fistula. Our patient presented with severe portal hypertension and cardiomyopathy along with robust arteriovenous connections between the IMA and IMV. Arterial embolization in this patient had to be followed by venous embolization for successful resolution of portal hypertension and cardiomyopathy. This case also highlights that close outpatient monitoring for treatment failure and recurrence is necessary for this disease process.

Keywords: Amplatzer; Arteriovenous fistula and malformation; Embolization; Inferior mesenteric artery; Inferior mesenteric vein; Portal hypertension.

Publication types

Case Reports