Management of Pancreatico-duodenal arterio-venous malformation

Clement Marcelin, Auh Whan Park, Patrick Gilbert, Louis Bouchard, Eric Therasse, Pierre Perreault, Marie France Giroux, Gilles Soulez

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Article number2
JournalCVIR Endovascular
Volume5
Issue number1
DOIs
StatePublished - Dec 2022
Externally publishedYes

Keywords

  • AVM
  • Embolization
  • Pancreas
  • Percutaneous

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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