Endovascular treatment of unique colonic arteriovenous malformation with dual supply from superior and inferior mesenteric arteries

Colonic arteriovenous malformations (AVMs) are well recognized in the literature and commonly manifest as colitis, abdominal pain, and rare cases have been reported of liver congestion. Dual-supply superior artery/ inferior mesenteric artery (SMA/IMA) colonic AVMs have never been reported and only one case of treating portal hypertension due to an AVM with an endovascular approach has been reported. We present a case of dual-supply SMA/IMA colonic AVM manifesting as hepatic venous congestion and demonstrate an endovascular approach to treatment. Level of evidence: Level 4, case series.

The liver in systemic disease

The liver may be involved in systemic diseases that primarily affect other organs. In most cases, the systemic disease should be treated effectively first. Circulatory disturbances can cause liver dysfunction by ischaemia (due to arterial hypoperfusion) and hepatic venous congestion. The liver is a key organ in sepsis, both as source of inflammatory mediators and as a victim of the inflammatory response. An oncological process may affect hepatic function in a number of ways. For example, tumours in and around the liver can affect function by directly reducing the volume of healthy, functioning tissue or by causing biliary obstruction, and portal venous infiltration or hypercoagulability may compromise the liver’s vascular supply. This chapter discusses the liver in systemic disease, including sections on etiology, symptoms, demographics, complications, diagnosis, and treatment.