In Reply to: Case 0498_02 -- Mesenteric artery to portal vein fistula posted by Editor on March 31, 1998 at 14:48:08:
A covered stent (Corvita would fit well) would almost certainly work. The web images are not very clear but it seems that the arterioportal communication is very short, hence the difficulty in stabilising embolization devices. To prevent emboli falling through you could stent across the fistula and then put coils inside the stent. There is enough collateralization from IMA and celiac for this to be done even if you need to occlude several cm of the proximal SMA. What size coils were used?? Very oversized coils (2 or more x SMA diameter) could be laid down starting distal to the fistula to fix them more securely across the mouth of the fistula, then smaller coils could be laid within that framework.