Arteriovenous malformation of the pancreas is a very rare entity. We describe a case involving the head of the pancreas associated with progressive hemobilia bleeding from the lower part of the common bile duct. The patient was a 50-year-old man with acute epigastralgia. Endoscopic retrograde cholangiopancreatography revealed hemobilia and cystic dilation of the common bile duct. Angiography demonstrated increased blood volume in the head of the pancreas and early filling of the superior mesenteric and portal veins. Abdominal pain and progressive anemia caused by hemobilia required surgical treatment. Histologic examination of the resected specimen revealed marked proliferation of the blood vessels in the pericholedochal area and the exact point of bleeding from the pancreaticobiliary arteriovenous malformation.
Material and Methods We retrospectively reviewed our prospectively maintained Neuro IR database and identified all patients who underwent transradial access for their diagnostic or interventional procedure between May 2019 and January 2021. Patient demographics, clinical information, procedural and radiographic data were collected. Results We identified 749 patients in whom transradial access was obtained for either diagnostic and interventional Neuro IR procedures. Access was obtained using a 5F/6F/7F radial sheath. In some procedures, the sheath was exchanged for the guide catheter which was then inserted in a bareback (sheathless) fashion. Interventional procedures performed included carotid artery stenting, stroke thrombectomy, intracranial stenting, thrombolysis for central retinal artery occlusion, aneurysm treatment (with coiling or stent-assisted coiling, flow diverters or Woven EndoBridge device placement), vasospasm treatment, arteriovenous malformation and dural arteriovenous fistula embolization, middle meningeal artery embolization, and spinal angiography with embolization. A total of 12 access site complications were recorded (1.6%) with 4 access site hematomas, 3 inflammatory changes at the puncture site, 2 asymptomatic radial artery occlusions, 2 radial artery injuries (1 self-limiting wire perforation and 1 perforation which was coiled via transfemoral route without any clinical sequela) and 1 retained broken microwire which was successfully removed in a subsequent session. None of the complications resulted in permanent local or neurological deficits. Conclusion The transradial approach for diagnostic and interventional Neuro IR procedures is a safe vascular access choice.
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