Brief report
Endovascular Repair of Traumatic Mesocaval Fistula

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A patient presented with a posttraumatic fistula between the superior mesenteric artery and inferior vena cava with associated pseudoaneurysm after multiple thoracoabdominal gunshot wounds. Endovascular management with placement of two overlapping stent-grafts resulted in complete resolution of the lesions with documented patency at 15 months and no known complications. This minimally invasive therapy spared the patient the morbidity of conventional open surgical repair.

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Case Report

A 20-year-old man was brought by paramedics to a level III trauma center after sustaining two gunshot wounds. One wound was identified in the lower sternum and the other in the left midclavicular line just below the costal margin. Abdominal sonography demonstrated free fluid and radiographic images showed a bullet fragment in the right lower quadrant. In hemodynamically unstable condition, the patient was resuscitated and transported directly to the operating room.

At laparotomy, there was

Discussion

Injuries to major vascular structures such as the IVC or SMA are often life-threatening. Traumatic abdominal AV fistulas were first described before World War II (1). Although such lesions have long been managed surgically, in the recent literature, endovascular treatment with use of stent-grafts has been described in aortocaval fistulas (2, 3) and renal AV fistulas (4). In 1999, Parodi et al (2) described permanent endovascular stent repairs of traumatic arterial injuries, including 19

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