Superior Mesenteric Arteriovenous Fistula: A Case Report And Literature Review

BackgroundSuperior Mesenteric Arteriovenous Fistula(SMAVF)is clinically rare.The world's first report was reported by Munnell and Mota in 1960.Domestic reports have been filed since 1970 and have been dominated by cases.The number is small,lack of corresponding clinical guidelines,and it is easy to cause missed diagnosis and misdiagnosis of this disease,which has a serious impact on the treatment and prognosis of patients.ObjectiveThrough a case report and literature review of mesenteric arteriovenous fistula,the clinical manifestations,diagnosis,differential diagnosis,treatment methods,status and treatment progress of mesenteric arteriovenous fistula were improved.Information and methodsA case report of patients with mesenteric arteriovenous fistula(SMAVF)in the First Affiliated Hospital of Zhengzhou University was reported.The clinical manifestations,diagnosis,differential diagnosis,treatment and prognosis wereanalyzed in combination with the case reports published by the China Journal Full-text Database(CNKI).ResultsArteriovenous fistular(AVF)refers to the occurrence of direct blood flow short circuit between arteries and veins for some reasons.It is a rare vascular disease.Arteriovenous fistula is common in limbs,mesenteric arteriovenous fistula.(SMAVF)is characterized by an abnormal direct communication between the high-pressure superior mesenteric artery(SMA)and the low-pressure superior mesenteric vein(SMV).This shunt causes blood to bypass the intestinal capillary bed and produce high blood pressure in the portal vein.The cause of MAVFs may be congenital or may be the result of a disorder associated with connective tissue;however,the most common cause of SMAVFs is post-traumatic.This usually occurs in penetrating trauma or abdominal surgery,such as small bowel resection,colectomy,aortic double-valve bypass,and renal pancreas transplantation.Mesenteric arteriovenous fistula(SMAVF)is clinically rare,and its clinical symptoms are atypical.The clinical manifestations are closely related to the specific location and size of the fistula.The initial clinical manifestations are often abdominal pain,diarrhea,etc.,and even some patients may be Asymptomatic,late stage due to secondary portal hypertension(PHTN)to produce clinical manifestations of portal hypertension,such as: massive ascites,hypoproteinemia,gastrointestinal bleeding,etc.,and the relevant clinical manifestations often do not occur First,some patients appear in the days after surgery,while others appear many years later.Due to the atypical clinical manifestations,they are often misdiagnosed as other gastrointestinal diseases,such as incomplete intestinal obstruction and gastrointestinal tumors.Often it brings difficulties to clinical diagnosis.SMAVF usually progresses over time,delaying treatment can lead to serious complications and a great image for the patient's prognosis and quality of life.If left untreated,this condition can lead to portal hypertension,congestive heart failure,massive variceal bleeding,or progressive liver failure.The overall mortality rate of untreated SMAVF was 25%.Imaging diagnosis of arteriovenous fistula In thepast,DSA was considered to be the "gold standard" for diagnosis.Considering the invasiveness and radiation factors of DSA,and the development of imaging technology,the accuracy and sensitivity of CT,CTA and ultrasound are also checked.Gradually improve.Ultrasound can be used as the initial diagnostic imaging method because it does not present any risks associated with the use of radiation or contrast agents.CTA in the arterial and venous phases should also be considered a diagnostic method for diagnosis.However,the gold standard for diagnosis remains the intraoperative DSA,which has the highest sensitivity and specificity and is the gold standard for determining the exact anatomical location and extent of mesenteric vascular involvement.The main treatments for the disease include surgery and interventional therapy.Surgical treatment is the most traditional method,the goal is to remove the fistula,reconstruct the arterial blood flow to the intestine,and keep the venous return unobstructed.However,significant morbidity and mortality associated with surgical treatment have made interventional radiology a priority.ConclusionMesenteric arteriovenous fistula(SMAVF)is rare in clinical practice,and most patients have a history of trauma,and the clinical manifestations of patients are not typical.Clinical manifestations are clinical symptoms such as abdominal distension,weight loss,massive ascites,and hypoproteinemia.Such patients,combined with CT,CTA,ultrasound,DSA and other imaging examinations,to confirm the diagnosis,to avoid misdiagnosis or missed diagnosis.At present,the main treatment of this disease is mainly interventional therapy and surgical treatment,combined with the patient's condition,choose the appropriate treatment.