Endovascular treatment of an iatrogenic superior mesenteric arteriovenous fistula after Nissen fundoplication

We present a case of a superior mesenteric arteriovenous fistula (SMAVF) diagnosed four years after index Nissen fundoplication and examine the associated imaging, clinical course, and surgical treatment followed by a review of the limited, available literature. From a transbrachial approach, a covered stent was successfully deployed in the superior mesenteric artery to exclude the fistula after confirmation of the site of pathology on both digital subtraction angiography and intravascular ultrasound. Follow-up imaging demonstrated continued exclusion of the anomalous fistula with complete resolution of his symptoms at both his postprocedure and 1-year follow-up visits. SMAVFs are usually encountered secondary to previous surgical dissection or trauma and presents with nondescript abdominal pain making early diagnosis difficult; however, they can be successfully treated with minimally-invasive stent exclusion