Fig. 3
From: Management of Pancreatico-duodenal arterio-venous malformation
A 66 yo women with a cryptogenic cirrhosis who underwent previous abdominal surgery for colorectal carcinoma and chronic portal vein thrombosis presented recurrent ascites and chronic pancreatitis. A CT scans showing a Yakes type IIIa pancreatic AVM (arrow), with an aneurysmal splenic vein (dashed arrow). B Selective angiography of the splenic artery showed a pancreatic AVM, vascularized by the dorsal pancreatic artery (arrow), splenic artery, left gastric artery, and connected to an aneurysmal splenic vein (dashed arrow). C After puncture of splenic vein, venography showing the aneurysmal splenic vein draining into the gastroduodenal and mesenteric veins because of the preexisting portal thrombosis (dashed arrow). D Insertion of a covered stent in the splenic vein (dashed arrow) by a transplenic access and embolization using Onyx® and coils after direct puncture of the aneurysm. The patient had subsequent splenic venous thrombosis which was successfully treated by mechanical thrombectomy and heparin infusion. E Doppler ultrasound at 1 year showed permeability of the splenic and portal veins (dashed arrow), with no residual AVM.