Overview
Jejunal arterio-venous fistulas are abnormal connections between arteries and veins in the jejunum, often resulting from prior surgery, trauma, infection, or spontaneously 1. These fistulas can lead to significant hemodynamic disturbances and require prompt diagnosis and intervention.Diagnosis
Clinical Presentation: Acute upper abdominal pain, vomiting, and audible bruits 1.
Diagnostic Imaging:
- MR Imaging: Essential for visualizing the fistula and associated vascular abnormalities 1.
- Color Doppler Ultrasound: Useful noninvasive tool for confirming the diagnosis 1.
Angiography:
- Transfemoral angiography to assess anatomy and feasibility of embolization 1.
- Identifies aneurysms, abnormal vascular filling patterns, and portal vein dilation 1.Management
Primary Treatment:
- Superselective Catheter Embolization: Using microcoils for definitive closure 1.
Techniques:
- Employ of tracker-18 catheters for precise navigation 1.Special Populations
Post-Surgical Patients: Increased risk due to prior pancreatic head resection 1.Key Recommendations
Auscultate the abdomen during initial clinical examination to detect abnormal bruits indicative of arterio-venous fistulas (Evidence: Expert opinion) 1.
Utilize MR imaging as the primary noninvasive diagnostic tool for confirming jejunal arterio-venous fistulas (Evidence: Moderate) 1.
Consider superselective catheter embolization with microcoils as the first-line treatment approach for definitive closure (Evidence: Weak) 1.References
1 Sonnenschein MJ, Anderson SE, Lourens S, Triller J. A rare case of jejunal arterio-venous fistula: treatment with superselective catheter embolization with a tracker-18 catheter and microcoils. Cardiovascular and interventional radiology 2004. link