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Shin SH, Cho CK, Yu SY. Pancreatic arteriovenous malformation treated with transcatheter arterial embolization: Two case reports and review of literature. World J Clin Cases 2023; 11:6920-6930. [PMID: 37901023 PMCID: PMC10600833 DOI: 10.12998/wjcc.v11.i28.6920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/09/2023] [Accepted: 09/05/2023] [Indexed: 09/25/2023] Open
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.
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Affiliation(s)
- Sang Hoon Shin
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun 58128, Jeollanam-do, South Korea
| | - Chol Kyoon Cho
- Department of Surgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun 58128, Jeollanam-do, South Korea
| | - Sung Yeol Yu
- Department of Surgery, Chonnam National University Hospital, Gwangju 61469, South Korea
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Onozawa S, Miyauchi R, Takahashi M, Kuroki K. An Update of Treatment of Pancreatic Arteriovenous Malformations. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:49-55. [PMID: 37485485 PMCID: PMC10359168 DOI: 10.22575/interventionalradiology.2022-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/19/2023] [Indexed: 07/25/2023]
Abstract
Pancreatic arteriovenous malformation is a rare entity (0.9%). There are about 200 articles available in PubMed. This review article includes 86 published articles, with 117 cases published after 2000. The median age at diagnosis was 51, and most of the patients were male (87.0%). The symptoms included pain, bleeding, pancreatitis, ulcers in the duodenum or stomach, varix formation, jaundice, and ascites. The diagnostic modalities were angiography, contrast-enhanced CT, MRI, and/or Ultra Sound. The most common treatments were surgery and embolization. The clinical success rate of embolization reported was 57.7%. The tailored embolization based on each agio-architecture had a clinical success rate of 80%. If embolic therapy is ineffective, surgical intervention should be considered.
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Affiliation(s)
- Shiro Onozawa
- Department of Radiology, Kyorin University, Faculty of Medicine, Japan
| | - Ryosuke Miyauchi
- Department of Radiology, Kyorin University, Faculty of Medicine, Japan
| | - Masaki Takahashi
- Department of Radiology, Kyorin University, Faculty of Medicine, Japan
| | - Kazunori Kuroki
- Department of Radiology, Kyorin University, Faculty of Medicine, Japan
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Marcelin C, Park AW, Gilbert P, Bouchard L, Therasse E, Perreault P, Giroux MF, Soulez G. Management of Pancreatico-duodenal arterio-venous malformation. CVIR Endovasc 2022; 5:2. [PMID: 34978632 PMCID: PMC8724485 DOI: 10.1186/s42155-021-00269-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022] Open
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.
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Affiliation(s)
| | - Auh Whan Park
- Department of Radiology, UVA Health, Charlottsville, VA, USA
| | | | | | - Eric Therasse
- CHUM Université de Montréal, Montreal, Québec, Canada
| | | | | | - Gilles Soulez
- CHUM Université de Montréal, Montreal, Québec, Canada.
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Wu W, An FD, Piao CL, Tan MK, Si ZD, Xin L, Zhao N, Leng JJ. Management of pancreatic arteriovenous malformation: Case report and literature review. Medicine (Baltimore) 2021; 100:e27983. [PMID: 34941037 PMCID: PMC8702121 DOI: 10.1097/md.0000000000027983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Pancreatic arteriovenous malformation (P-AVM) is a rare vascular malformation. Fewer than 200 cases have been reported. The clinical manifestations lack specificity. Common symptoms include abdominal pain, gastrointestinal hemorrhage, and jaundice, which is easily confused with other disorders. PATIENT CONCERNS A 42-year-old man received TAE due to abdominal pain caused by P-AVM in a local hospital, melena and abdominal pain occurred in a short time after TAE. DIAGNOSIS The patient was diagnosed as P-AVM which was confirmed by computed tomography and digital subtraction angiography. INTERVENTIONS A pylorus-preserving pancreatoduodenectomy was successfully performed after diagnosis was made. OUTCOMES The patient recovered with no complications two weeks after surgery, and no sign of recurrence was found during the 4-mo follow-up period. CONCLUSION In our experience, TAE may have limitations in the treatment of P-AVM and surgical resection should be considered as the treatment of choice.
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Rajesh S, Mukund A, Bhatia V, Arora A. Transcatheter embolization of pancreatic arteriovenous malformation associated with recurrent acute pancreatitis. Indian J Radiol Imaging 2016; 26:95-8. [PMID: 27081231 PMCID: PMC4813082 DOI: 10.4103/0971-3026.178352] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Pancreatic arteriovenous malformation (PAVM) is extremely rare; even rarer is its association with pancreatitis. The authors report a case of PAVM causing recurrent episodes of acute pancreatitis in a 46-year-old male. Patient refused surgery and was treated with transcatheter arterial embolization using liquid embolic agent (mixture of n-butyl-2-cyanoacrylate glue and lipiodol), which resulted in a significant decrease in the size of the PAVM.
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Affiliation(s)
- S Rajesh
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vikram Bhatia
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ankur Arora
- Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
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Martínez-Moneo E, Fernández Laso AB. [Acute pancreatitis due to venous artery malformation]. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 39:276-277. [PMID: 25983282 DOI: 10.1016/j.gastrohep.2015.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 03/23/2015] [Accepted: 03/30/2015] [Indexed: 06/04/2023]
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Abstract
Pancreatic arteriovenous malformation is a rare vascular anomaly which may cause abdominal pain, acute pancreatitis, gastrointestinal bleeding and portal hypertension. Pancreatic arteriovenous malformation is mostly congenital; however secondary pancreatic arteriovenous malformation due to pancreatitis has been suggested by some authors. We encountered a case which can confirm this presumption. Several imaging modalities are useful for the diagnosis of pancreatic arteriovenous malformation, especially dynamic contrast-enhanced studies. Angiography is the most important diagnostic tool because of the dynamic features of this vascular lesion. Treatment is advised and consists of surgical resection and/or transarterial embolization.
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Yamabuki T, Ohara M, Kimura N, Okamura K, Kuroda A, Takahashi R, Komuro K, Iwashiro N. Pancreatic arteriovenous malformation. Case Rep Gastroenterol 2014; 8:26-31. [PMID: 24574946 PMCID: PMC3934809 DOI: 10.1159/000358193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
An unusual case of pancreatic arteriovenous malformation (P-AVM) combined with esophageal cancer is reported. A 59-year-old man was admitted with upper abdominal pain. Contrast-enhanced computed tomography showed numerous strongly enhanced abnormal vessels and a hypovascular lesion in the area of the pancreatic tail. Angiographic study of the celiac artery confirmed racemose vascular networks in the tail of the pancreas. Endoscopic retrograde pancreatography revealed narrowing and displacement of the main pancreatic duct in the tail of the pancreas. Screening esophagoscopy showed a 0-IIa+IIc type tumor in the lower thoracic esophagus. Histological examination of esophagoscopic biopsies showed squamous cell carcinoma. Based on these findings, P-AVM or pancreatic cancer and esophageal cancer were diagnosed. Video-assisted thoracoscopic esophagectomy and distal pancreatectomy were performed. Histological examination of the resected pancreas revealed abundant abnormal vessels with intravascular thrombi. In addition, rupture of a dilated pancreatic duct with pancreatic stones and both severe atrophy and fibrosis of the pancreatic parenchyma were observed. The final diagnoses were P-AVM consequent to severe chronic pancreatitis and esophageal carcinoma. The patient's postoperative course was relatively good.
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Affiliation(s)
- Takumi Yamabuki
- Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Masanori Ohara
- Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Noriko Kimura
- Pathology, National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Kunishige Okamura
- Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Aki Kuroda
- Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Ryo Takahashi
- Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Kazuteru Komuro
- Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Nozomu Iwashiro
- Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan
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Clinical experiences in the treatment of pancreatic arteriovenous malformation by total pancreatectomy with islet autotransplantation. Transplantation 2013; 96:e38-40. [PMID: 23995868 DOI: 10.1097/tp.0b013e3182a01333] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chou SC, Shyr YM, Wang SE. Pancreatic arteriovenous malformation. J Gastrointest Surg 2013; 17:1240-6. [PMID: 23636883 DOI: 10.1007/s11605-013-2217-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 04/23/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pancreatic arteriovenous malformation is very rare, but may cause significant clinical symptoms such as catastrophic bleeding. Herein, we discuss the clinical presentation and management of patients pancreatic arteriovenous malformations. METHODS The data pool for the analysis was collected from pancreatic arteriovenous malformation cases encountered by our institution and sporadic case reports in the English literature. RESULTS A total of 89 cases of pancreatic arteriovenous malformation were collected for this study, including 59 cases of arteriovenous malformation in the pancreatic head (62.3 %) and 30 in the pancreatic body-tail (33.7 %). The most commonly associated complications for overall cases of pancreatic arteriovenous malformation were bleeding (50.6 %), pancreatitis (16.9 %), portal hypertension (6.7 %), and pseudocyst (3.4 %). The most common presenting symptom of pancreatic arteriovenous malformation was gastrointestinal bleeding (47.2 %), followed by epigastric pain (46.1 %). Surgery (43.8 %) was the most common treatment for pancreatic arteriovenous malformation cases, followed by transarterial embolization (11.2 %), a combination of surgery and transarterial embolization (10.1 %), and radiotherapy (2.2 %). No intervention was done for 29.2 % of the cases of pancreatic arteriovenous malformation. CONCLUSIONS Pancreatic arteriovenous malformation occurs most commonly in the pancreatic head; gastrointestinal bleeding is the main symptom. Surgical resection or transarterial embolization appears to be indicated in patients with symptomatic pancreatic arteriovenous malformation.
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Affiliation(s)
- Shu-Cheng Chou
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming University, 10 F 201 Section 2 Shipai Road, Taipei, 112, Taiwan
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Abstract
OBJECTIVE Pancreatic arteriovenous malformation (P-AVM) is an extremely rare condition that can be accompanied by fatal complications. We have attempted to identify the possible management guidelines based on our and others' clinical experience. METHODS We retrospectively analyzed our findings including clinical characteristics, imaging modalities, and treatment in 12 patients. Sporadic reports of 69 patients with P-AVM were surveyed for representative characteristics and treatment strategy. RESULTS The mean age at diagnosis was 49.8 years (range, 44-64 years), and all 12 were male. The mean body mass index was 21.5 kg/m (range, 18.3-24.3 kg/m) and 6 (50%) were heavy smokers (mean, 30.9 pack-years; range, 7.5-120 pack-years). The most common clinical symptom is gastrointestinal bleeding, followed by abdominal pain. All patients were diagnosed with abdominal disease using computed tomography. Of the 12 patients, 11 underwent pancreatic resection and 1 patient was managed conservatively. No patient experienced any major postoperative complications during the median follow-up of 37 months. CONCLUSIONS In patients with symptomatic P-AVM, surgical resection of the affected pancreas showed a successful result. When a patient is at a high risk for surgical treatment, transjugular intrahepatic portosystemic shunt, transarterial embolization, and radiation therapy might be other treatment options.
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Part 2: CT characterisation of pancreatic neoplasm: tumour mimics. Insights Imaging 2011; 2:389-397. [PMID: 22347960 PMCID: PMC3259386 DOI: 10.1007/s13244-011-0103-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 02/28/2011] [Accepted: 05/04/2011] [Indexed: 12/18/2022] Open
Abstract
There are numerous pancreatic and peripancreatic conditions that can mimic pancreatic neoplasms. Many of these can be confidently diagnosed on computed tomography (CT), while others will require further imaging. Knowledge of these tumour mimics is important to avoid misclassification of benign conditions as malignant and to avoid unnecessary surgery. Mimics can be grouped as parenchymal, vascular, biliary and peripancreatic. These are discussed and illustrated in this review.
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Itoh S, Mori Y, Suzuki K, Satake H, Ota T, Naganawa S. Stenosis of the third portion of the duodenum due to bleeding from the anterior pancreaticoduodenal artery: assessment by multiphase contrast-enhanced examination with multislice CT. ABDOMINAL IMAGING 2010; 35:393-398. [PMID: 19568807 DOI: 10.1007/s00261-009-9547-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Accepted: 06/03/2009] [Indexed: 05/28/2023]
Abstract
BACKGROUND This study was undertaken to analyze the CT findings for the rare pathological process that stenosis of the third portion of the duodenum was presumed to be caused by bleeding from the anterior pancreaticoduodenal artery. METHODS Four consecutive patients presenting with frequent vomiting, who did not have well-known underlying disorders causing duodenal stenosis, were retrospectively recruited. Multiphase contrast-enhanced CT examinations were performed with 0.5- or 1-mm collimation. Two radiologists evaluated 2-mm axial and multiplanar reformatted images. RESULTS In all patients, endoscopy demonstrated severe edematous stenosis of the third portion of the duodenum not associated with ulcer, bleeding, or neoplasm. The following CT findings were observed in all patients: homogenous swelling of the third portion of the duodenum associated with luminal stenosis in un-enhanced images, a band-like area of lower contrast-enhancement surrounding the walls of the third portion of the duodenum in pancreatic-phase images, and stenosis of the celiac axis. In three patients, aneurysms of the anterior pancreaticoduodenal artery in arterial-phase images were depicted. In the remaining patient, the diameter of the artery was irregular. CONCLUSIONS Multiphase contrast-enhanced CT examination using a multislice CT scanner helps to establish the diagnosis of this pathological process.
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Affiliation(s)
- Shigeki Itoh
- Department of Technical Radiology, Nagoya University School of Health Sciences, 1-1-20 Daikou-minami, Higashi-ku, Nagoya, Aichi 461-8673, Japan.
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Choi JK, Lee SH, Kwak MS, Kim JH, Jang ES, Hwang SW, Hwang JH, Joo LJ, Yoon YS, Kim HR. A Case of Recurrent Acute Pancreatitis due to Pancreatic Arteriovenous Malformation. Gut Liver 2010; 4:135-9. [PMID: 20479928 DOI: 10.5009/gnl.2010.4.1.135] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2009] [Accepted: 08/11/2009] [Indexed: 11/04/2022] Open
Abstract
Pancreatic arteriovenous malformation (AVM) is an extremely rare condition with various clinical manifestations. We report herein a case of recurrent acute pancreatitis due to pancreatic AVM in a 49-year-old man. This patient presented with epigastric pain that had developed after consuming alcohol 2 days prior to admission. Serum amylase and lipase levels were elevated and computed tomography revealed focal low-attenuation lesions with peripancreatic infiltrations in the pancreatic tail and multiple collateral vessels around the low-attenuation lesions. He was diagnosed with acute pancreatitis and pancreatic AVM. Although he had stopped drinking after the first attack of acute pancreatitis, his pancreatitis recurred twice within 3 months. He underwent a distal pancreatectomy after the third attack of acute pancreatitis. He was free of symptoms for 2 years after the pancreatectomy.
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Affiliation(s)
- Jong Kyoung Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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