Detection and Intervention of Clinically Masquerading Inferior Mesenteric Artery AVMs

Abstract

We demonstrate a rare case of inferior mesenteric artery arteriovenous malformations leading to ischemic colitis in a 76-year-old female. Our patient presented with three months of nausea, vomiting, and diarrhea. Colonoscopy displayed diffuse mucosal vascular congestion while CTA and MRA displayed AVMs in the region of the IMA; however, cohesive clinical agreement on AVM from multiple specialties was difficult given its rare occurrence and nonspecific clinical, histopathologic, and directly visualized findings. The three noted dominant AVMs were eventually selected with coil and liquid embolization with successful cessation of symptoms and no major complications. Our discussion focuses on intervention and stressing the importance of radiologic findings, as IMA AVMs, rarely present as ischemic colitis and therefore can clinically masquerade as other etiologies.

Trans-arterial embolization of a Yakes type IIb inferior mesenteric arteriovenous malformation: A case report and literature review for angio-architecture analysis

“…Six cases of embolization failure via the TA route were due to persistent or recurring symptoms in the short term [7 , 12 , 29] , deterioration of ischemia [19 , 20] , technical issues [21] , and AVM rupture after embolization [33] . Among the 9 cases of successful embolization via the TA route, our patient had frequent diarrhea, which disappeared after 6 months; 1 patient had paroxysmal abdominal pain after embolization [16] , which disappeared after a few days; and the remaining 7 patients had no complications after embolization and recovered well [11 , 13 , 27 , 32 , 34 , 35 , 40] . All 5 patients who underwent successful transvenous (TV) route embolization [10 , 14 , 26 , 28 , 31] developed no complications and recovered well ( Fig.…”

“…The curative intervention for Yakes type II AVM/AVF is complete sclerosis of the nidus using a liquid embolic such as ethanol [32] , glue (our case), foam [10] , or onyx [11 , 13 , 14 , 20] . However, the use of a liquid embolic requires experience; incomplete devascularization of the nidus can lead to persistent symptoms [29] or symptom recurrence [7] .…”

“…Considering the clarity of available images for angioarchitecture analysis, we conducted a literature review of PubMed from 1988 to 2022 using the keywords “inferior mesenteric artery,” “arteriovenous malformation,” and “fistula” and found 39 cases. After excluding those without angiography [2] , those with poor imaging quality [3] , and those with an unclear relationship between the nidus and outflow veins in imaging examinations [4 , 5] , we conducted an angioarchitecture analysis of 33 cases [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] in addition to our own (34 total cases), as listed in Table 1 .…”

Inferior mesenteric artery arteriovenous malformation, a rare cause of ischemic colitis: A case report

“…Treatment options include endovascular embolization, surgical intervention, and a combination of both. [2,[7][8][9][10] Embolization can be the definitive treatment alone or as a bridge prior to the operation. However, embolization carries the risk of bowel ischemia and recurrence of the AVMs had been reported if inadequate embolization was performed.…”

Diagnostic value of mesenteric CTA combined with D-dimer level and inflammatory factor changes in severity of mesenteric artery embolism

“…In case of inconsistent diagnosis, the original and reconstructed images were re-observed by the two physicians referring to the international general visual method for evaluation of the vessel diameter. 8 The calculation formula was as follows: the degree of vascular stenosis = (normal vessel diameter of the proximal part at the stenosis site - vessel diameter at the stenosis site)/normal vessel diameter of the proximal part at the stenosis site × 100%. Superior mesenteric artery stenosis was divided into three degrees: mild, stenosis < 50%; moderate, stenosis = 50%~74%, and severe, stenosis = 75%~100%.…”