Endovascular Repair of a Superior Mesenteric Arteriovenous Fistula and Pseudoaneurysm After a Single Gunshot Wound to the Abdomen.

Abstract

Background: Traumatic arteriovenous fistulas (AVFs) are rare entities, especially when referring to visceral arterioportal AVFs. Currently, there are no large epidemiological studies looking specifically at traumatic visceral AVFs. When traumatic AVFs have been discussed in the literature, it is in the form of case reports or case series and focused on peripheral AVFs. The following case is a presentation of a traumatic arterioportal AVF and its management with an endovascular approach.

Case presentation: A 16-year-old adolescent boy presented tachycardic and hypotensive with a single gunshot wound in his left abdomen. Multiple operations were required. His intensive care unit course was remarkable for persistent hypertension despite multiple antihypertensive medications. A computed tomography angiography (CTA) of the abdomen and pelvis showed a superior mesenteric arteriovenous fistula (AVF) with pseudoaneurysm. He underwent endovascular repair of this traumatic visceral AVF and pseudoaneurysm. This rare case illustrates the presentation, diagnosis, and treatment of a traumatic visceral arterioportal fistula with pseudoaneurysm.

Conclusion: Traumatic AVF and visceral vascular injuries are rare. A CTA of the abdomen can be diagnostic, and we demonstrate that endovascular techniques can be diagnostic and therapeutic. Further studies are needed to compare the long-term outcomes of open versus endovascular techniques.