In Reply to: Case 0498_02 -- Mesenteric artery to portal vein fistula posted by Editor on March 31, 1998 at 14:48:08:
It appears that the origin of this fistula was proximal to the origin of the middle colic artery and therefore in the absence of a covered stent or a long GDC coil, and failing to control it with the first detatchable balloon as you did, I would have tried to catheterize the origin of inferior pancreaticoduodenal artery in order to place one or two 3-5 mm Gianturco coils in it to prevent retrograde flow from this artery and pancretatic arcade into the SMA and fistula. Then would have gained control of the fistula by placing a 9x 40mm angioplasty balloon in the proximal SMA covering the proximal SMA extending over the fistula into the SMA distal to the fistula but not obstructing the origin of the middle colic artery and would have sent the patient to OR for simple ligation of the SMA at its origin and at a point proximal to the origin of the middle colic both of which are easily accessible surgically. Because there was a well developed collateral from IMA to SMA distal to the middle colic the bowel would have survived such ligation without compromise.