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

Abstract

Background: Various treatment methods are available for the treatment of pancreatic arteriovenous malformation (P-AVM); however, there are no established treatment options for asymptomatic P-AVM.

Case summary: A 47-year-old and a 50-year-old male patients sought treatment for P-AVM in the pancreas, which was incidentally detected during routine abdominal computed tomography and magnetic resonance imaging conducted as part of a health check-up. They underwent transcatheter arterial embolization (TAE), and over the course of a 9-year follow-up period, the AVM did not worsen and was asymptomatic.

Conclusion: TAE can be considered as an alternative treatment option for P-AVM in selective cases where patients are asymptomatic or have a high surgical risk.

Keywords: Angiography; Asymptomatic; Case report; Pancreatic arteriovenous malformation; Surgical treatment; Transcatheter arterial embolization.

Figure 1

Abdominal computed tomography and magnetic resonance imaging findings before transcatheter arterial embolization (case 1). A and B: Abdominal computed tomography images demonstrating early arterial filling of the portal vein (A) and a 3.7 cm hypervascular lesion in the pancreas head (B); C: Additionally, magnetic resonance imaging image showing a similar lesion.

Figure 2

Abdominal computed tomography and magnetic resonance imaging before transcatheter arterial embolization (case 2). A: Computed tomography image showing a 5.2 cm × 4.0 cm enhancing tortuous, tubular hypervascular lesion in the pancreas neck, and body; B: Magnetic resonance imaging image showing a 2 cm multilobulated and irregular hypervascular lesion in the pancreatic neck and body with peripancreatic infiltration.

Figure 3

Abdominal endoscopic ultrasonography (case 2). Abdominal endoscopic ultrasonography showing the presence of an approximately 2.0 cm cystic lesion.

Figure 4

Angiography and transcatheter arterial embolization (case 1). A: Angiographic images revealing multiple feeding branches supplying blood flow to the nidus; B: While the interventional image shows the use of interlock coils to occlude the pancreaticoduodenal arcade and dorsal pancreatic artery.

Figure 5

Arteriography and transcatheter arterial embolization (case 2). A: Angiographic images of feeding branches from the proper hepatic artery and the dorsal pancreatic artery; B: The feeding branches are then treated with interlock coils to block the blood supply to the abnormal vessels in the pancreas.

Figure 6

Abdominal computed tomography performed on day 5 after transcatheter arterial embolization (case 1). Post-transcatheter arterial embolization image showing improvement in arteriovenous malformation and a slight reduction in peripancreatic hypervascular lesions.

Figure 7

Esophagogastroduodenoscopy performed on day 10 after transcatheter arterial embolization (case 1). The presence of ischemic duodenitis is evident, characterized by segmental circumferential erythematous uneven mucosal changes with nodularity.

Figure 8

Follow-up abdominal computed tomography scans three months and nine years after the procedure (case 1). A: The computed tomography (CT) scan after three months revealed a 3.7 cm hypervascular lesion; B: While the CT scan after nine years showed a reduction in the size of the hypervascular lesions to 2.3 cm.

Figure 9

Abdominal computed tomography findings before transcatheter arterial embolization (case 2). Post-transcatheter arterial embolization computed tomography scan performed on the 4^th day revealed reduced contrast enhancement.

Figure 10

Follow-up abdominal computed tomography scan. A: On the three-year follow-up computed tomography scan, there was no significant change in the lesion size, which measured 5.7 cm × 3.3 cm; B: On the nine-year follow-up scale, the lesion size remained at 6.0 cm × 3.0 cm.