Efficacy of Arterial Embolization prior to Pancreaticoduodenectomy for Pancreatic Arteriovenous Malformation: A Case Report

Abstract

INTRODUCTION: Pancreatic arteriovenous malformation is a rare disease characterized by abnormal vascular connections between arteries and veins. Despite the risk of increased intraoperative blood loss due to abundant blood flow, surgical resection remains the only curative modality for pancreatic arteriovenous malformation. We present a case of pancreatic arteriovenous malformation in which subtotal stomach-preserving pancreaticoduodenectomy was successfully performed following selective arterial embolization to reduce intraoperative blood loss.

CASE PRESENTATION: A 53-year-old Southeast Asian man was referred to our hospital with abdominal pain. Contrast-enhanced computed tomography revealed enhancement of the pancreatic head and superior mesenteric vein in the early arterial phase, suggesting the presence of an arteriovenous malformation. Maximum intensity projection images and angiography revealed arterial branches from the gastroduodenal artery and superior mesenteric artery to the arteriovenous malformation, subsequently draining into the portal venous circulation. We supposed that abdominal pain resistant to medical treatment was due to the pancreatic arteriovenous malformation, and surgical resection was deemed necessary. Subtotal stomach-preserving pancreaticoduodenectomy was safely performed on the day after arterial embolization of pancreatic arterial branches to reduce intraoperative blood loss. The procedure resulted in an intraoperative blood loss of 336g. The patient was discharged on the 16th postoperative day with no complications and has not experienced abdominal pain since.

CONCLUSIONS: Selective arterial embolization prior to pancreaticoduodenectomy against pancreatic arteriovenous malformation is a safe and feasible procedure to reduce intraoperative blood loss.