In Reply to: Case 0498_02 -- Mesenteric artery to portal vein fistula posted by Editor on March 31, 1998 at 14:48:08:
The transhepatic approach could be helpful in this case to try and occlude the A-V fistula while embolizing from the arterial side. This is obviously the ultimate challenge for any interventionalist. Asking the surgeons to do it would have been the simple thing to do. I would have created access from both the arterial and portal sides. One could inflate an occlusion balloon into the pancreatic portal branch to stop the flow and then come from the arterial side and embolize with a million coils. Covered stent in the SMA would be a risky proposition. Probably would be easier to deploy it from the axilla. This would my last resort though.