Endovascular treatment of a pancreatic pseudoaneurysm associated with massive pancreatic arteriovenous malformation using flow modification technique

Pancreatic arteriovenous malformation (PAVM) is a rare vascular anomaly of the gastrointestinal tract, and the coexistence of a pseudoaneurysm is exceptionally uncommon. This report details a case of pseudoaneurysm associated with a massive PAVM that was successfully managed with endovascular therapy. A 67-year-old female patient with a massive PAVM presented with acute back pain. Contrast-enhanced computed tomography revealed a pseudoaneurysm in the pancreatic head accompanied by a surrounding haematoma. Transcatheter arterial embolisation (TAE) was selected as the minimally invasive treatment and the pseudoaneurysm was visualised on angiography. However, identifying the culprit artery was challenging due to the extensive vascular network of the PAVM. Following modification of the local haemodynamics using coil embolisation, the culprit artery became detectable, allowing successful embolisation of the pseudoaneurysm using N-butyl cyanoacrylate (NBCA). This case report highlights the clinical utility of NBCA embolisation combined with flow modification for managing a pseudoaneurysm associated with a massive PAVM, which represents an exceptionally rare vascular anomaly.