Overview
Mesenteric-portal fistulas are abnormal connections between mesenteric arteries and portal veins, often resulting from trauma, surgery, or underlying vascular pathology, leading to significant hemodynamic disturbances and potential complications like portal hypertension and bleeding 12.Diagnosis
Imaging studies (CT angiography, MRI) essential for identifying fistula location and extent 12.
Endoscopic evaluation may reveal signs of portal hypertension or bleeding 2.
Hemodynamic instability and laboratory findings indicative of portal hypertension (elevated INR, thrombocytopenia) 2.Management
Endovascular interventions: Stent graft placement in affected arteries (e.g., gastroduodenal artery) for arterial repair 1.
Surgical options: Interpositional shunting for portal decompression in cases of uncontrolled bleeding 2.
Embolization: Initial approach for fistula closure, though may be insufficient alone 2.Special Populations
Trauma patients: Portal decompression via shunting may be necessary for managing recurrent bleeding 2.
No specific guidance provided for pregnancy, pediatrics, or elderly populations in the given abstracts.Key Recommendations
Consider endovascular stent graft placement for managing mesenteric arterioportal fistulas arising from arterial pseudoaneurysms 1 (Evidence: Moderate).
In cases of traumatic hepatic artery-portal vein fistulas with uncontrolled bleeding, portosystemic shunting can be a viable therapeutic option for portal decompression 2 (Evidence: Weak).
Initial attempts at embolization should be considered, but surgical or additional endovascular interventions may be required for definitive closure 2 (Evidence: Weak).References
1 Krishan S, McPherson S, Pine J, Hayden J. Current management of mesenteric extrahepatic arterioportal fistulas: report of a case treated with a gastroduodenal artery stent graft and literature review. Vascular and endovascular surgery 2010. link
2 Down NK, Makowka L, Langer B, Colapinto R, Wensel RH. Successful treatment of a traumatic hepatic artery-portal vein arteriovenous fistula by interpositional mesocaval shunting. Canadian journal of surgery. Journal canadien de chirurgie 1987. link