# Loeys-Dietz Syndrome Presenting as Hemorrhage From Arteriobiliary Fistula: Endoscopic Management of Hemostasis

## TL;DR

A patient with Loeys-Dietz Syndrome and a complex vascular condition was successfully treated with a metallic stent to stop severe bleeding from an arteriobiliary fistula.

## Contribution

The paper introduces the novel use of a fully covered metallic stent for hemostasis in a challenging case of arteriobiliary fistula.

## Key findings

- A fully covered metallic stent achieved hemostasis in a patient with Loeys-Dietz Syndrome and arteriobiliary fistula.
- Embolization of hepatic artery branches failed to control the hemorrhage in this complex case.
- Endoscopic retrograde cholangiopancreatography was used to place the stent successfully.

## Abstract

Loeys-Dietz syndrome is a rare autosomal dominant connective tissue disorder with an increasing risk of vascular aneurysm formation and dissection. In this report, we discuss the novel therapeutic use of a fully covered metallic stent for management of severe refractory hemorrhage from arteriobiliary fistula in a case complicated with Loeys-Dietz Syndrome and post thoracic aneurysm repair. Recent history of pancreaticoduodenectomy added on the anatomy complexity, and embolization of hepatic artery branches proved unsuccessful. Hemostasis was achieved after a metallic stent placement in the common bile and hepatic duct via endoscopic retrograde cholangiopancreatography.