title: Inferior mesenteric arteriovenous fistula: case report and world-literature review.
abstract: Arteriovenous fistulas between the inferior mesenteric artery and vein are rare, with only 26 primary and secondary cases described in the literature. Secondary fistulas occur following operations of the left hemicolon and manifest as abdominal pain, abdominal mass, gastrointestinal bleeding, colonic ischemia and portal hypertension. Symptom intensities are flow-dependent, and can range from minimal symptoms to severe heart failure due to left to right shunt. Diagnosis is usually established by radiological or intraoperative examination. Treatment options include embolization and/or surgical resection. Therapeutic decisions should be adapted to the unique characteristics of the fistula on an individual basis. A new case of a primary arteriovenous fistula is described and discussed along with a complete review of the literature. The patient in this report presented with signs and symptoms of colonic ischemia without portal hypertension. The optimal treatment for this patient required a combination of embolization and surgical operation. The characteristics of these rare inferior mesenteric arteriovenous fistulas are examined and some considerations concerning diagnostic and therapeutic strategies that should be followed are presented.
authors.affiliation: Antonios Athanasiou, Adamantios Michalinos, Andreas Alexandrou, Sotirios Georgopoulos, Evangelos Felekouras, First Department of Surgery, Laikon University Hospital, Athens 11527, Greece.
authors.forename: Antonios
authors.initials: A
authors.lastname: Athanasiou
authors.affiliation: Antonios Athanasiou, Adamantios Michalinos, Andreas Alexandrou, Sotirios Georgopoulos, Evangelos Felekouras, First Department of Surgery, Laikon University Hospital, Athens 11527, Greece.
authors.forename: Adamantios
authors.initials: A
authors.lastname: Michalinos
authors.affiliation: Antonios Athanasiou, Adamantios Michalinos, Andreas Alexandrou, Sotirios Georgopoulos, Evangelos Felekouras, First Department of Surgery, Laikon University Hospital, Athens 11527, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Alexandrou
authors.affiliation: Antonios Athanasiou, Adamantios Michalinos, Andreas Alexandrou, Sotirios Georgopoulos, Evangelos Felekouras, First Department of Surgery, Laikon University Hospital, Athens 11527, Greece.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Georgopoulos
authors.affiliation: Antonios Athanasiou, Adamantios Michalinos, Andreas Alexandrou, Sotirios Georgopoulos, Evangelos Felekouras, First Department of Surgery, Laikon University Hospital, Athens 11527, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Felekouras
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001164:Arteriovenous Fistula / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D003082:Colectomy; D003106:Colon / Q000098:blood supply*; D003125:Colostomy; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000000981:diagnostic imaging; D065666:Mesenteric Ischemia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D008642:Mesenteric Veins / Q000000981:diagnostic imaging; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Arteriovenous fistula; Colectomy; Embolization; Inferior mesenteric artery; Portal hypertension