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Wang et al. Vessel Plus 2018;2:7 Vessel Plus
DOI: 10.20517/2574-1209.2018.15

Case Report Open Access

Endovascular treatment of an iatrogenic superior
mesenteric arteriovenous fistula after Nissen

fundoplication

S. Keisin Wang, Jie Xie, Raghu L. Motaganahalli

Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.

Correspondence to: Dr. Raghu L. Motaganahalli, Division of Vascular Surgery, Department of Surgery, Indiana University School
of Medicine, 1801 N. Senate Blvd MPC2-3500, Indianapolis, IN 46202, USA. E-mail: rmotagan@iupui.edu; Dr. S. Keisin Wang,
Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, 1801 N. Senate Blvd MPC2-3500,
Indianapolis, IN 46202, USA. E-mail: wangkei@iupui.edu
How to cite this article: Wang SK, Xie J, Motaganahalli RL. Endovascular treatment of an iatrogenic superior mesenteric
arteriovenous fistula after Nissen fundoplication. Vessel Plus 2018;2:7. http://dx.doi.org/10.20517/2574-1209.2018.15

Received: 27 Mar 2018 First Decision: 24 Apr 2018 Revised: 24 Apr 2018 Accepted: 26 Apr 2018 Published: 27 Apr 2018

Science Editor: Mario F. L. Gaudino Copy Editor: Jun-Yao Li Production Editor: Cai-Hong Wang

Abstract
We present a case of a superior mesenteric arteriovenous fistula (SMAVF) diagnosed four years after index Nissen
fundoplication and examine the associated imaging, clinical course, and surgical treatment followed by a review of
the limited, available literature. From a transbrachial approach, a covered stent was successfully deployed in the
superior mesenteric artery to exclude the fistula after confirmation of the site of pathology on both digital subtraction
angiography and intravascular ultrasound. Follow-up imaging demonstrated continued exclusion of the anomalous
fistula with complete resolution of his symptoms at both his postprocedure and 1-year follow-up visits. SMAVFs are
usually encountered secondary to previous surgical dissection or trauma and presents with nondescript abdominal pain
making early diagnosis difficult; however, they can be successfully treated with minimally-invasive stent exclusion.

Keywords: Superior mesenteric artery, iatrogenic, fistula, endovascular, stent, treatment

INTRODUCTION
A superior mesenteric arteriovenous fistula (SMAVF) is a rare pathology that can lead to gastrointestinal
bleeding, portal hypertension, and hepatic dysfunction if allowed to progress . Although limited outcomes
[1]
data is available, endovascular therapy is preferred secondary to a lower postoperative morbidity compared
to open surgical repair .
[2]

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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