Management of pancreatic arteriovenous malformation

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.

Rare Cause of Gastrointestinal Bleeding: A Case Report of Pancreatic Arteriovenous Malformation

“…The surgery resolves the cause of bleeding, which prevents the development of portal hypertension [ 5 ]. TAE, transjugular intrahepatic portosystemic shunt, and radio-therapy can be alternative approaches for patients with portal hypertension or for those at high risk for surgery [ 12 , 13 ]. Some authors suggest that preoperative TAE can reduce the blood flow to the portal system and the risk of recurrent bleeding after surgery.…”

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

“…P-AVM is a rare condition characterized by the abnormal connection between the arterial and portal systems in the pancreas, resulting in tumor formation and blood flow abnormalities[ 8 ]. Histological examinations usually identify dilated and twisted blood vessels within the pancreatic parenchyma as well as collections of irregularly tortuous blood vessels with thick walls[ 3 , 9 , 10 ].…”

“…The median age of the patients in their study was 50 years. Furthermore, Wu et al [ 3 ] (2021) reported a male predominance (24 males, 2 females) among P-AVM patients, with an average age at diagnosis of 51.5 years.…”

“…It also plays an important role in treatment planning by identifying feeding arteries and determining the optimal target for embolization[ 17 , 18 ]. According to Wu et al [ 3 ] (2021), Color Doppler ultrasonography is a useful diagnostic tool for P-AVM, particularly in identifying the characteristic "mosaic sign" of vascular malformation associated with P-AVM.…”

“…Since its initial description by Halpern et al [ 1 ] in 1968, fewer than 100 cases of P-AVM have been reported in the literature[ 2 ]. P-AVM can present with various symptoms including abdominal pain, gastrointestinal (GI) hemorrhage, and jaundice, or it may be discovered incidentally without any specific symptoms[ 3 ].…”