ABSTRACT
BACKGROUND: 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. CASE PRESENTATION: 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. CONCLUSIONS: 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 OF EVIDENCE: Level 4, Case Report.
Subject(s)
Leiomyoma , Uterine Artery Embolization , Uterine Myomectomy , Arteries , Female , Humans , Leiomyoma/surgerySubject(s)
Heart Neoplasms/surgery , Heart Ventricles/surgery , Hemangioma/surgery , Pericardium/surgery , Pulmonary Artery/surgery , Ventricular Outflow Obstruction/surgery , Disease Management , Heart Neoplasms/chemically induced , Heart Neoplasms/diagnostic imaging , Heart Ventricles/diagnostic imaging , Hemangioma/complications , Hemangioma/diagnostic imaging , Humans , Male , Middle Aged , Pericardium/diagnostic imaging , Perioperative Care/methods , Pulmonary Artery/diagnostic imaging , Ventricular Outflow Obstruction/diagnostic imaging , Ventricular Outflow Obstruction/etiologySubject(s)
Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Heart Valve Prosthesis Implantation/adverse effects , Mycobacterium Infections/etiology , Osteomyelitis/etiology , Spinal Diseases/etiology , Surgical Wound Infection/etiology , Aged , Fatal Outcome , Humans , Lumbar Vertebrae , Magnetic Resonance Imaging , Male , Mycobacterium/isolation & purification , Mycobacterium Infections/diagnosis , Mycobacterium Infections/microbiology , Osteomyelitis/diagnosis , Osteomyelitis/microbiology , Spinal Diseases/diagnosis , Spinal Diseases/microbiology , Surgical Wound Infection/diagnosis , Surgical Wound Infection/microbiology , Thoracic VertebraeSubject(s)
Aortic Diseases/physiopathology , Arterial Occlusive Diseases/physiopathology , Collateral Circulation , Iliac Artery/physiopathology , Aged , Aortic Diseases/diagnostic imaging , Aortography/methods , Arterial Occlusive Diseases/diagnostic imaging , Computed Tomography Angiography , Humans , Iliac Artery/diagnostic imaging , Male , Regional Blood FlowABSTRACT
The anatomy of aortic aneurysms from the proximal neck to the access vessels may create technical challenges for endovascular repair. Upwards of 30% of patients with abdominal aortic aneurysms (AAA) have unsuitable proximal neck morphology for endovascular repair. Anatomies considered unsuitable for conventional infrarenal stent grafting include short or absent necks, angulated necks, conical necks, or large necks exceeding size availability for current stent grafts. A number of advanced endovascular techniques and devices have been developed to circumvent these challenges, each with unique advantages and disadvantages. These include snorkeling procedures such as chimneys, periscopes, and sandwich techniques; "homemade" or "back-table" fenestrated endografts as well as manufactured, customized fenestrated endografts; and more recently, physician modified branched devices. Furthermore, new devices in the pipeline under investigation, such as "off-the-shelf" fenestrated stent grafts, branched stent grafts, lower profile devices, and novel sealing designs, have the potential of solving many of the aforementioned problems. The treatment of aortic aneurysms continues to evolve, further expanding the population of patients that can be treated with an endovascular approach. As the technology grows so do the number of challenging aortic anatomies that endovascular specialists take on, further pushing the envelope in the arena of aortic repair.
ABSTRACT
Cavernous sinus thrombosis (CST) is a rare condition that can cause death, neurologic disability, and visual loss. A pre-teen with septic CST leading to ocular hypertension and acute visual loss was treated at our institution with thrombectomy and thrombolysis of the cavernous sinuses and superior ophthalmic veins. Successful recanalization of the bilateral cavernous sinuses and superior ophthalmic veins was achieved in two separate procedures without complication. The patient showed immediate symptomatic relief. He was neurologically intact without visual deficits at the 2 month follow-up. This is the first report in the literature showing the feasibility of cavernous sinus thrombectomy using current devices and techniques. Early endovascular therapy may help preserve vision in patients with acute CST.
Subject(s)
Cavernous Sinus Thrombosis/diagnostic imaging , Cavernous Sinus Thrombosis/surgery , Femoral Vein/diagnostic imaging , Orbit/blood supply , Orbit/diagnostic imaging , Thrombectomy/methods , Cavernous Sinus Thrombosis/complications , Child , Humans , Male , Ocular Hypertension/etiology , Veins/diagnostic imaging , Veins/surgeryABSTRACT
Cavernous sinus thrombosis (CST) is a rare condition that can cause death, neurologic disability, and visual loss. A pre-teen with septic CST leading to ocular hypertension and acute visual loss was treated at our institution with thrombectomy and thrombolysis of the cavernous sinuses and superior ophthalmic veins. Successful recanalization of the bilateral cavernous sinuses and superior ophthalmic veins was achieved in two separate procedures without complication. The patient showed immediate symptomatic relief. He was neurologically intact without visual deficits at the 2 month follow-up. This is the first report in the literature showing the feasibility of cavernous sinus thrombectomy using current devices and techniques. Early endovascular therapy may help preserve vision in patients with acute CST.
Subject(s)
Cavernous Sinus Thrombosis/therapy , Orbit/blood supply , Thrombectomy/methods , Veins , Venous Thrombosis/therapy , Anticoagulants/administration & dosage , Cavernous Sinus Thrombosis/complications , Cavernous Sinus Thrombosis/diagnostic imaging , Child , Fluoroscopy , Humans , Male , Ocular Hypertension/etiology , Orbit/diagnostic imaging , Plasminogen Activators/administration & dosage , Retreatment/methods , Tomography, X-Ray Computed , Veins/diagnostic imaging , Venous Thrombosis/diagnostic imagingABSTRACT
45-year-old female presenting initially with fever, nonproductive cough, night sweats, pleuritic chest pain, fatigue and weight loss over the past month.