Fig. 2
From: Management of Pancreatico-duodenal arterio-venous malformation
A 57 yo women with upper GI bleeding. A- CT scan showed a nidus in the pancreatic head (dotted arrow). B- Selective angiography of the pancreatic dorsal artery (black arrow) showing a type IIIB pancreatic AVM, with multiple feeding arteries draining in an aneurysmal vein (white arrow) both draining into the portal vein. C- Selective angiography of the gastroduodenal artery showing multiple arterial collaterals (black arrow), vascularized by multiples branches of the postero-superior and antero-superior pancreatico-duodenal arteries (white arrow). Embolization with Onyx® of the dorsal pancreatic artery (large black arrow). D- Portal venous access showed an enlarged pancreatic vein (black arrow) draining into the portal vein (big black arrow). E- Pressure cooker technique: proximal embolization of the draining gastroduodenal vein using a plug (white arrow), and then distal embolization with STS using a microcatheter distal to the Plug in order to reflux into the nidus (black arrow) of the AVM. F- Selective angiography of the celiac trunk showing a residual pancreatic AVM (arrow).