SUPERIOR MESENTERIC ARTERIOVENOUS-FISTULA IN VASCULARIZED WHOLE-ORGANPANCREATIC ALLOGRAFTS

Despite improved results in vascularized pancreatic transplantation, t he incidence of technical complications continues to be high. Vascular complications are an important source of morbidity. Previously undesc ribed is the occurrence of an arteriovenous fistula (AVF) in the trans planted mesenteric bundle. We have identified this unusual complicatio n in three of 90 consecutive recipients of pancreatic transplant. The first patient presented with severe and protracted endocrine insuffici ency, which was effectively reversed by direct surgical ligation of th e AVF. The second patient presented with hematuria, which likewise, re solved with correction of the AVF. The third instance was diagnosed im mediately after transplant and was successfully corrected by direct su rgical ligation. The operative approach with establishment of proximal vascular control differed in each instance. Clinical presentation was variable and diagnosis was suggested by physical examination, duplex ultrasonography and radionuclide perfusion scanning. Arteriography was confirmatory. Mesenteric AVF can be easily identified and corrected a t the time of reoperation without compromising allograft function.