Intestinal arteriovenous malformation managed with palliative ligation and division of the feeding artery: a case report

TL;DR

A case report describes managing intestinal arteriovenous malformation with artery ligation to avoid bowel resection and preserve the ileocecal valve.

Contribution

Presents a novel palliative approach using feeding artery ligation for intestinal AVM instead of resection.

Findings

Ligation and division of the feeding artery preserved the ileocecal valve and managed bleeding effectively.

Recurrence is possible due to vessel interconnection and non-degeneration of the AVM nidus.

Long-term follow-up is essential for patients treated with this palliative method.

Abstract

Arteriovenous malformation (AVM) is a congenital vascular anomaly characterized by an abnormal connection between arteries and veins, bypassing the capillary system. AVM is commonly found in the central nervous system, as well as in the peripheral vascular system and the gastrointestinal tract. Symptomatic intestinal AVM (I-AVM) may present as gastrointestinal bleeding, ranging from occult bleeding to hematochezia. Diagnosis depends on the severity of symptoms, hemodynamic status, and location and size of the lesion and involves either endoscopy, arteriography, or contrast-enhanced computed tomography. Treatment varies based on the diagnostic modality used, such as endoscopic coagulation/clipping, trans-arterial embolization, or intestinal resection. Bleeding I-AVM located in the terminal ileum and presenting with a single prominent feeding artery can be managed with palliative ligation and division of the feeding artery rather than using bowel resection to preserve the ileocecal valve. Lifetime clinical follow-up is necessary due to the recurrence of bleeding secondary to vessel interconnection via the vasa recta and non-degeneration of the AVM nidus.

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