PMC6033256_01
Axial post-intravenous contrast computed tomography showing arterialised enhancement of the superior mesenteric vein with a large fistula from the adjacent superior mesenteric artery.
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An urgent computed tomography (CT) scan was performed immediately after laparotomy, which demonstrated a large SMAVF arising from proximal SMA, close to the origin of several early jejunal branches, and communicating with the cranial aspect of the SMV (Fig. 1).
Digital subtraction superior mesenteric artery (SMA) angiogram showing (A) rapid shunting to the portal vein via a large superior mesenteric arteriovenous fistula (SMAVF), with no flow into distal SMA branches, and (B) following stent grafting of the proximal SMA, exclusion of SMAVF and much improved flow into the distal SMA branches.
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Three ADVANTA V12 Atrium balloon mounted stent grafts (Macquet, Rastatt, Germany) were required to completely exclude the SMAVF, landing in the distal main SMA trunk (5 mm x 22 mm, 6 mm x 22 mm, and 6 mm x 38 mm) (Fig. 2).
Cinematic volume rendered technique using computed tomography angiogram performed four days after stent placement and showing complete patency of superior mesenteric artery branches and exclusion of the superior mesenteric arteriovenous fistula.
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A repeat CT 4 days after stent insertion confirmed a patent SMA, SMV, and portal vein with no evidence of persistent SMAVF (Fig. 3).