Endovascular Occlusion of Giant Posttraumatic Pseudo-Aneurysm of Superior Mesenteric Artery Connected to Mesenteric Arteriovenous Fistula.

Autor:	Dzhagraev KR; Leading Researcher, Department of Emergency Surgery, Endoscopy and Resuscitation; N.V. Sklifosovsky Research Institute of Emergency Care, 3 Bolshaya Sukharevskaya Square, Moscow, 129090, Russia; Associate Professor, Department of Emergency and General Surgery; Russian Medical Academy of Continuous Professional Education, 2/1, Bldg 1, Barrikadnaya St., Moscow, 125993, Russia., Muslimov RS; Leading Researcher, Department of Radiation Diagnostics; N.V. Sklifosovsky Research Institute of Emergency Care, 3 Bolshaya Sukharevskaya Square, Moscow, 129090, Russia., Klimov AB; Physician, Department of X-ray Surgery Diagnosis and Therapy; N.V. Sklifosovsky Research Institute of Emergency Care, 3 Bolshaya Sukharevskaya Square, Moscow, 129090, Russia., Ryabukhin VE; Physician, Department of X-ray Surgery Diagnosis and Therapy; N.V. Sklifosovsky Research Institute of Emergency Care, 3 Bolshaya Sukharevskaya Square, Moscow, 129090, Russia., Kim TE; Physician, 2 Surgery Department; N.V. Sklifosovsky Research Institute of Emergency Care, 3 Bolshaya Sukharevskaya Square, Moscow, 129090, Russia., Selina IE; Leading Researcher, Department of Radiation Diagnostics; N.V. Sklifosovsky Research Institute of Emergency Care, 3 Bolshaya Sukharevskaya Square, Moscow, 129090, Russia., Kiryushchenkov VP; Physician, Department of X-ray Surgery Diagnosis and Therapy; N.V. Sklifosovsky Research Institute of Emergency Care, 3 Bolshaya Sukharevskaya Square, Moscow, 129090, Russia., Moskalenko VA; Physician, Department of X-ray Surgery Diagnosis and Therapy; N.V. Sklifosovsky Research Institute of Emergency Care, 3 Bolshaya Sukharevskaya Square, Moscow, 129090, Russia., Kokov LS; Professor, Academician of the Russian Academy of Sciences, Head of the Department of Radiation Diagnostics; N.V. Sklifosovsky Research Institute of Emergency Care, 3 Bolshaya Sukharevskaya Square, Moscow, 129090, Russia; Head of the Radiodiagnosis Department, Institute of Professional Education I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya St., Moscow, 119991, Russia.
Jazyk:	angličtina
Zdroj:	Sovremennye tekhnologii v meditsine [Sovrem Tekhnologii Med] 2021; Vol. 12 (4), pp. 55-61. Date of Electronic Publication: 2020 Aug 27.
DOI:	10.17691/stm2020.12.4.07
Abstrakt:	The aim of the study was to show the capabilities of endovascular occlusion of giant posttraumatic pseudo-aneurysm of superior mesenteric artery (SMA) connected to a mesenteric arteriovenous fistula (AVF) under the conditions of portal hypertension and life-threatening esophageal variceal bleeding. Materials and Methods: A 27-old male patient underwent endovascular occlusion; the patient being hospitalized with a clinical picture of gastrointestinal bleeding. The examinations: ultrasound, esophagogastroduodenoscopy, multispiral computed tomography with angiography - revealed the source of bleeding to be esophageal varices against the background of portal hypertension caused by massive arteriovenous shunt, its source being AVF with an aneurysmal component (32×35 mm in size) between SMA and superior mesenteric vein (SMV) dilated up to 50 mm in diameter. Patient's past medical history recorded that 4.5 years ago the patient had undergone the resection of a small intestine area due to a penetrating stab wound in the abdominal cavity. Taking into consideration an extremely high operative intervention risk due to the condition severity related to blood loss, portal hypertension, and ascites, it was decided to embolize AVF with a vascular occluder - Amplatzer Vascular Plug II (USA), 14×10 mm in size. Results: A unique endovascular intervention - transcatheter occlusion of pseudo-aneurysm and AVF separation - was performed in life-threatening esophageal variceal bleeding under the condition of a giant post-traumatic aneurysm of SMA and mesenteric AVF. Due to an extremely large-sized SMV and an arterial pseudo-aneurysm, first ever we used the technique applied for transcatheter occlusion of a cardiac septum defect.Occluder implantation enabled to completely close the communication of aneurysmatic AVF with SMV, and occlude the aneurysm cavity. During an immediate postoperative period portal hypertension was arrested. No recurrent bleedings occurred within 4 postoperative months.
Databáze:	MEDLINE
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