Transportal Embolization of the Dominant Outflow Vein for a Pancreatic Head Arteriovenous Malformation: A Case Report.

Pancreatic arteriovenous malformation is a rare vascular disorder for which no established treatment strategy exists. We report the case of an asymptomatic but progressively enlarging pancreatic head arteriovenous malformation in a 66-year-old man with alcoholic liver cirrhosis who had undergone multiple transarterial chemoembolization procedures for hepatocellular carcinoma. Angiography revealed multiple fine arterial feeders from the distal gastroduodenal artery and proximal anterior superior pancreaticoduodenal artery converging into a single dominant outflow vein draining into the superior mesenteric vein, consistent with a Cho type II / Yakes type IIIa arteriovenous malformation. Based on this classification, coil embolization of the dominant outflow vein was performed via a percutaneous transhepatic portal venous approach. The procedure was completed safely, and follow-up angiography confirmed complete and persistent shunt obliteration.