title: Embolization of pancreatic allograft arteriovenous fistula with the Amplatzer Vascular Plug 4: case report and literature analysis.
abstract: Vascular complications remain a major cause of graft loss after pancreatic transplantation. They include vascular thrombosis, pseudoaneurysm, and arteriovenous fistula (AVF). We report a case of an AVF that appeared 3 months after a simultaneous pancreas-kidney transplantation (SPKT). Doppler ultrasonography followed by magnetic resonance angiography and later angiography provided a definitive diagnosis of a mesenteric AVF. An endovascular approach is becoming the treatment of choice owing to the high risk of graft loss associated with open surgical correction. Microcoils alone, or in conjunction with detachable balloons, are frequently used; still, a new generation of vascular plugs seem to offer a therapeutic option for AVF closure, because it is a "1 shot" procedure that avoids the risk of accidental coil migration. A new-generation Amplatzer Vascular Plug 4 was deployed over the distal arterial branch of the superior mesenteric artery stump, leading to complete exclusion of the AVF and restoring normal vascular flow.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Parma, Parma Hospital, Parma, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Buttarelli
authors.forename: E
authors.initials: E
authors.lastname: Capocasale
authors.forename: C
authors.initials: C
authors.lastname: Marcato
authors.forename: M P
authors.initials: MP
authors.lastname: Mazzoni
authors.forename: M
authors.initials: M
authors.lastname: Iaria
authors.forename: C
authors.initials: C
authors.lastname: Rossi
mesh_terms: D000328:Adult; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D004867:Equipment Design; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D008642:Mesenteric Veins / Q000000981:diagnostic imaging; D016035:Pancreas Transplantation / Q000009:adverse effects*; D011859:Radiography; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler