Management of Pancreatico-duodenal Arterio-venous Malformation

Overview

Journal CVIR Endovasc

Date 2022 Jan 3

PMID 34978632

Citations 2

Authors

Clement Marcelin

Auh Whan Park

Patrick Gilbert

Louis Bouchard

Eric Therasse

Pierre Perreault

Marie France Giroux

Gilles Soulez

Affiliations

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Abstract

Purpose: To describe the interventional management and clinical outcome of pancreatico-duodenal arterio-venous malformations (PDAVMs).

Material And Methods: Seven patients presenting a PDAVM (6 women, 1 male; mean age: 61) were retrospectively reviewed. Technical, clinical success and complications of embolization and surgical management of symptomatic PDAVMs were assessed. Technical success was defined as a complete occlusion of the PDAVM and clinical success as no clinical symptom or recurrence during follow-up. Patients with asymptomatic PDAVMs were followed clinically, by Doppler ultrasound and CT-angiography.

Results: Mean follow-up time was 69 months (15-180). Five symptomatic patients presented with upper gastrointestinal bleeding (n=3), ascites (n=1), and abdominal pain (n=1). Two patients were asymptomatic. The PDAVMs were classified as follow: Yakes I (1), IIIa (2), IIIb (3) and IV (1). Five symptomatic patients were treated with 9 embolization sessions with arterial approach (onyx®, glue, coils) in 7 and venous approach in 2 (plugs, coils, covered stents, STS foam and onyx®). Technical success of embolization was 60% (3/5). Devascularization was incomplete for 2 Yakes IIIB patients. Clinical success of embolization was estimated at 80% (4/5) as one patient required additional surgery (Whipple) because of persistent bleeding. One splenic vein thrombosis was treated successfully by mechanical thrombectomy and heparin. No recurrence occurred during follow-up. No progression was documented in asymptomatic patients.

Conclusion: Embolization of symptomatic PDAVMs is effective and surgery should be performed in second intention. Complete devascularization is more difficult to obtain in Yakes III PDAVM.

Citing Articles

Pancreatic arteriovenous malformation treated with transcatheter arterial embolization: Two case reports and review of literature.

Shin S, Cho C, Yu S World J Clin Cases. 2023; 11(28):6920-6930.

PMID: 37901023 PMC: 10600833. DOI: 10.12998/wjcc.v11.i28.6920.

An Update of Treatment of Pancreatic Arteriovenous Malformations.

Onozawa S, Miyauchi R, Takahashi M, Kuroki K Interv Radiol (Higashimatsuyama). 2023; 8(2):49-55.

PMID: 37485485 PMC: 10359168. DOI: 10.22575/interventionalradiology.2022-0037.

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