Two cases of pancreatic arteriovenous malformations treated with coil embolization via percutaneous transhepatic portal vein approach

TL;DR

Two patients with pancreatic arteriovenous malformations were successfully treated using a transhepatic portal vein embolization approach without arterial embolization.

Contribution

A novel transhepatic portal vein embolization approach for treating pancreatic arteriovenous malformations is presented.

Findings

Both patients showed successful outcomes with no adverse events during follow-up.

In one case, no residual AVM was observed after treatment.

Portal venous pressure significantly decreased in one patient after treatment.

Abstract

Endovascular treatment for pancreatic arteriovenous malformation (P-AVM) has primarily involved transarterial approach. Here, we present two patients with P-AVMs, both of whom were treated using a percutaneous transhepatic portal vein approach in which coil embolization of the aneurysmal draining vein was conducted without arterial embolization. Contrast-enhanced computed tomography revealed a P-AVM with several feeding arteries and minimal veins, with Yakes types IIIa and IIIb presented in Cases 1 and 2, respectively. In Case 1, no residual AVM was observed. In Case 2, several residual feeding arteries were observed immediately post-embolization; however, they further reduced in number after 4 months. In Case 2, the portal venous pressure decreased from 22 mmHg to 14 mmHg. No adverse events were observed during the follow-up.

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