Management of Pancreatico-duodenal arterio-venous malformation

CVIR Endovascular

Marie France Giroux¹  Clement Marcelin¹  Eric Therasse¹  Patrick Gilbert¹  Pierre Perreault¹  Gilles Soulez¹  Louis Bouchard¹  Auh Whan Park² 

[1] CHUM Université de Montréal, Montreal, Québec, Canada;Department of Radiology, UVA Health, Charlottsville, VA, USA;

关键词: Embolization;    AVM;    Pancreas;    Percutaneous;   

DOI  :  10.1186/s42155-021-00269-9

来源: Springer

【 摘 要 】

PurposeTo describe the interventional management and clinical outcome of pancreatico-duodenal arterio-venous malformations (PDAVMs).Material and MethodsSeven 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.ResultsMean 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.ConclusionEmbolization of symptomatic PDAVMs is effective and surgery should be performed in second intention. Complete devascularization is more difficult to obtain in Yakes III PDAVM.

【 授权许可】

CC BY