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Saito N, Inoue M, Ishida K, Taguchi H, Haga M, Shimoda E, Morimoto K, Takahama J, Tanaka T. A Case of Refractory Esophageal Varices Caused by an Inferior Mesenteric Arteriovenous Malformation with All Portal System Occlusion Successfully Treated via Transarterial Embolization. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:83-87. [PMID: 37485479 PMCID: PMC10359167 DOI: 10.22575/interventionalradiology.2022-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/22/2022] [Indexed: 07/25/2023]
Abstract
Inferior mesenteric arteriovenous fistulas/malformations are rare, reported in only 40 cases as of 2021. Their main manifestations include portal hypertension and ischemic bowel disease. We report the case of a 50-year-old man with refractory esophageal varices caused by this condition that was successfully treated with transarterial embolization. Computed tomography revealed an inferior mesenteric arteriovenous malformation and ascending blood flow into the esophageal varices through a remarkably dilated marginal vein. All portal systems were occluded, possibly because of the myointimal hyperplasia of the inferior mesenteric vein. The patient recovered without hemorrhagic events after transarterial embolization and endoscopic injection sclerotherapy. This is the first report of an inferior mesenteric arteriovenous malformation resulting in refractory esophageal varices with all-portal system occlusion successfully treated with transarterial embolization.
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Affiliation(s)
- Natsuhiko Saito
- Department of Radiology, Higashiosaka City Medical Center, Japan
| | - Masayoshi Inoue
- Department of Radiology, Higashiosaka City Medical Center, Japan
| | - Kentaro Ishida
- Department of Radiology, Higashiosaka City Medical Center, Japan
| | - Hidehiko Taguchi
- Department of Radiology, Higashiosaka City Medical Center, Japan
| | - Masayo Haga
- Department of Radiology, Higashiosaka City Medical Center, Japan
| | - Emiko Shimoda
- Department of Radiology, Higashiosaka City Medical Center, Japan
| | - Kengo Morimoto
- Department of Radiology, Higashiosaka City Medical Center, Japan
| | - Junko Takahama
- Department of Radiology, Higashiosaka City Medical Center, Japan
| | - Toshihiro Tanaka
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Japan
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Trans-arterial embolization of a Yakes type IIb inferior mesenteric arteriovenous malformation: A case report and literature review for angio-architecture analysis. Radiol Case Rep 2023; 18:1620-1627. [PMID: 36865618 PMCID: PMC9971117 DOI: 10.1016/j.radcr.2023.01.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 02/18/2023] Open
Abstract
We herein report a case of acute, massive lower gastrointestinal bleeding caused by Yakes type IIb inferior mesenteric arteriovenous malformation, which was successfully treated with endovascular embolization. The Yakes arteriovenous malformation classification provides curative treatment strategies based on specific angioarchitecture, thus serving as a valuable guide during treatment planning. We reviewed reported cases from 1988 to 2022 and conducted an angioarchitecture analysis based on the Yakes classification. We analyzed these reported cases to estimate the treatment success rates of surgery and embolization.
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Doi A, Takeda H, Umemoto K, Oumi R, Wada S, Hamaguchi S, Mimura H, Arai H, Horie Y, Mizukami T, Izawa N, Ogura T, Nakajima TE, Sunakawa Y. Inferior mesenteric arteriovenous fistula during treatment with bevacizumab in colorectal cancer patient: A case report. World J Gastrointest Oncol 2020; 12:1364-1371. [PMID: 33250967 PMCID: PMC7667451 DOI: 10.4251/wjgo.v12.i11.1364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/20/2020] [Accepted: 09/22/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Fistula formation is a severe adverse event related to antiangiogenetic agents such as bevacizumab and inferior mesenteric arteriovenous fistula (IMAVF) is a result of acquired factor, especially colon surgery. However, IMAVF occurs very rarely and there are few reports in patients during chemotherapy. We report a case of a patient who developed IMAVF during treatment with bevacizumab in metastatic colorectal cancer (mCRC) after colon surgery.
CASE SUMMARY An 81-year-old man was diagnosed with descending colon cancer and underwent left hemicolectomy without any complications. He was definitely diagnosed with high-risk stage 2 and received tegafur-uracil plus leucovorin as adjuvant chemotherapy. Three years and 6 mo after the operation, the cancer relapsed with peritoneal dissemination. The patient underwent CyberKnife radiosurgery targeting the recurrent tumor and received chemotherapy with S-1 plus bevacizumab. At 1 year after chemotherapy, he complained of severe diarrhea, which is suspected drug-induced colitis. As diarrhea worsened despite the termination of treatment, he underwent colonoscopy and computed tomography (CT) scans that revealed edematous change from sigmoid to rectosigmoid colon. CT scans also revealed an aneurysm adjacent to the inferior mesenteric vein and multidetector CT angiography showed the IMAVF. Elective angiography confirmed the diagnosis of an IMAVF and it was successfully treated by arterial embolization. The patient resumed chemotherapy with only S-1 6 mo after embolization.
CONCLUSION Clinicians should keep in mind the probability of severe diarrhea arose from IMAVF in mCRC patients treated with bevacizumab.
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Affiliation(s)
- Ayako Doi
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan
| | - Hiroyuki Takeda
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan
| | - Kumiko Umemoto
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan
| | - Ryosuke Oumi
- Department of Gastroenterology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan
| | - Shinji Wada
- Department of Radiology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan
| | - Shingo Hamaguchi
- Department of Radiology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan
| | - Hidefumi Mimura
- Department of Radiology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan
| | - Hiroyuki Arai
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan
| | - Yoshiki Horie
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan
| | - Takuro Mizukami
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan
| | - Naoki Izawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan
| | - Takashi Ogura
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan
| | - Takako Eguchi Nakajima
- Innovation Center for Next Generation Clinical Trials and iPS Cell Therapy, Kyoto University Hospital, Kyoto 606-8507, Japan
| | - Yu Sunakawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan
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