PMC5109286_01
A selective angiography for first jejunal branch (black arrow) of superior mesenteric artery showed poolings of the vessels and revealed an arteriovenous malformation as the source (white arrows).
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A selective angiography of the first jejunal branch of the superior mesenteric artery revealed an arteriovenous malformation as the source of bleeding (Fig. 1).
Dilute ICG (2 mL) was injected via the selective angiographic microcatheter, immediately staining a 8 cm segment of the proximal jejunum, and the region was recognized by the green color observed (arrow).
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We recognized that the region was green in color (Fig. 2), and the region could be easily and clearly visualized by the ICG fluorescence imaging (IFI) device (Photo dynamic emission camera; Hamamatsu Photonics K.K., Hamamatsu, Japan).
The region was observed using a fluorescence imaging device. The region could be easily and clearly visualized by the ICG fluorescence imaging (IFI), where dilated marginal arteries at an early phase (arrows) (A) and small patchy poolings of ICG at a late phase (oval) (B) were recognized.
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The region was recognized as dilated marginal arteries (Fig. 3A) and small patchy areas (Fig. 3B) in ICG stained jejunum.
Macroscopically, the mucosa of the resected specimen was patchy greenish (arrows), but the mucosa was almost intact.
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Macroscopically, the mucosa of the resected specimen was patchy greenish (Fig. 4).
Microscopic examination with elastica-masson staining revealed thick-and thin-walled sized arteries and veins (arrows). Histological evaluation revealed that the region showed an intact mucosal cover and numerous abnormal vessels in the submucosa (low-power magnification).
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The AVM diagnosis was characterized in the absence of malignancy (Fig. 5).