Contemporary Outcomes Associated with the Treatment of Mesenteric Arteriovenous Fistulas

Abstract

Mesenteric arteriovenous fistulas (mAVFs) are rare phenomena with majority of the literature comprised of case reports. The aim of this study was to perform a contemporary and comprehensive review of the etiology, treatment, and outcomes of mAVFs to aid in the management of this uncommon pathology. We performed a MEDLINE query for the terms arteriovenous, fistula, and mesenteric from 2010 to 2022. We included English language case reports and series. Data points of interest included treatment indications, clinical presentation, disease etiology, interventions, medical management, and postoperative outcomes. Fifty-three unique publications (all single patient) met the inclusion criteria resulting in a population of 53 subjects (Table). Mean age at presentation was 51 years with males more frequently affected than females (2:1). Etiology was most frequently classified as iatrogenic (49.1%), idiopathic (32.1%), and traumatic (17%); symptoms at presentation consisted of generalized abdominal pain (56.6%), hepatic dysfunction (45.3%), and gastrointestinal bleeding (34%). The most frequent intervention consisted of coil embolization (69.8%), stenting (13.2%), and open repair (13.2%). Open repair was undertaken in two cases due to the perceived risk of embolic agent migration into the portal venous system. Anticoagulation was the most employed medical therapy (20.8%), often related to the presence of unwanted thrombus formation in the immediate postoperative period (9.4%). The mean clinical follow-up period was 3 months (range, 0-60 months). Reintervention during follow-up (5.7%) were all secondary to incomplete fistula coiling requiring additional procedures. Perioperative mortality rate of 3.8% (n = 2) was encountered; one death due to the progression of metastatic carcinoma and the other secondary to portal venous thrombosis with subsequent congestive ischemia and multiorgan failure. The results herein suggest that mAVFs can have a wide range of clinical presentations, necessitating the importance of maintaining a high suspicion in patients with vague abdominal pain. In this series, coil embolization was the most employed treatment method, beneficial in patients who may present with multiple associated comorbidities including hepatic dysfunction and gastrointestinal bleeding.TableDemographics and Indications for RepairCharacteristicsMedian (range) or %Demographics Age, years51 (37-64) Male sex66.0 Transplant5.7 Active cancer13.2 Pancreatitis1.9 Trauma17.0 Iatrogenic49.1 Congenital1.9 Idiopathic30.2Indications for repair Hepatic dysfunction45.3 Gastrointestinal bleed34.0 Abdominal pain56.6 Mesenteric ischemia13.2 Free hemorrhage18.9 Emergent7.5 Thromboembolism0 Pseudoaneurysm17.0 Open table in a new tab