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Transvenous embolization of carotid cavernous fistulas via the superior ophthalmic vein.
Graefes Arch Clin Exp Ophthalmol. 2001 Aug; 239(8):583-8.GA

Abstract

BACKGROUND

Treatment of choice for symptomatic carotid-cavernous and cavernous-dural fistulas is neuroradiologic intervention via the femoral artery. Owing to the location of the fistula and/or to anatomic variations, a direct surgical approach via the superior ophthalmic vein may be necessary for embolization.

METHODS

Three patients presented with exophthalmos, episcleral venous congestion, chemosis, restricted eye movement, and secondary glaucoma. One patient had visual impairment and scotoma due to compression of the optic nerve by the fistula. The tentative diagnosis of an arteriovenous fistula was confirmed in two cases by color Doppler imaging and in all three cases with cerebral arterial angiography (two carotid-cavernous fistulas, one cavernous-dural fistula). After an unsuccessful transarterial attempt, embolization via the superior ophthalmic vein was chosen.

RESULTS

In all three patients the preparation of the superior ophthalmic vein was performed without any complications. In two cases the fistula could be embolized completely with platinum coils. In one patient the placement of the microcatheter was impossible, because of an abnormal vascular pattern. Later on the fistula was successfully embolized by an approach via the femoral vein. All three patients had complete resolution of symptoms. There were no recurrences.

CONCLUSION

Embolization of carotid-cavernous and cavernous-dural fistulas by a surgical approach via the superior ophthalmic vein represents safe and effective treatment when standard transarterial access is impossible. The cooperation of an orbital surgeon and an invasive neuroradiologist can be of benefit for this rare group of patients.

Authors+Show Affiliations

Department of Ophthalmology, Julius Maximilian University, Würzburg, Germany. t.klink@mail.uni-wuerzburg.deNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

11585314

Citation

Klink, T, et al. "Transvenous Embolization of Carotid Cavernous Fistulas Via the Superior Ophthalmic Vein." Graefe's Archive for Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle Ophthalmologie, vol. 239, no. 8, 2001, pp. 583-8.
Klink T, Hofmann E, Lieb W. Transvenous embolization of carotid cavernous fistulas via the superior ophthalmic vein. Graefes Arch Clin Exp Ophthalmol. 2001;239(8):583-8.
Klink, T., Hofmann, E., & Lieb, W. (2001). Transvenous embolization of carotid cavernous fistulas via the superior ophthalmic vein. Graefe's Archive for Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle Ophthalmologie, 239(8), 583-8.
Klink T, Hofmann E, Lieb W. Transvenous Embolization of Carotid Cavernous Fistulas Via the Superior Ophthalmic Vein. Graefes Arch Clin Exp Ophthalmol. 2001;239(8):583-8. PubMed PMID: 11585314.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transvenous embolization of carotid cavernous fistulas via the superior ophthalmic vein. AU - Klink,T, AU - Hofmann,E, AU - Lieb,W, PY - 2001/10/5/pubmed PY - 2002/2/8/medline PY - 2001/10/5/entrez SP - 583 EP - 8 JF - Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie JO - Graefes Arch. Clin. Exp. Ophthalmol. VL - 239 IS - 8 N2 - BACKGROUND: Treatment of choice for symptomatic carotid-cavernous and cavernous-dural fistulas is neuroradiologic intervention via the femoral artery. Owing to the location of the fistula and/or to anatomic variations, a direct surgical approach via the superior ophthalmic vein may be necessary for embolization. METHODS: Three patients presented with exophthalmos, episcleral venous congestion, chemosis, restricted eye movement, and secondary glaucoma. One patient had visual impairment and scotoma due to compression of the optic nerve by the fistula. The tentative diagnosis of an arteriovenous fistula was confirmed in two cases by color Doppler imaging and in all three cases with cerebral arterial angiography (two carotid-cavernous fistulas, one cavernous-dural fistula). After an unsuccessful transarterial attempt, embolization via the superior ophthalmic vein was chosen. RESULTS: In all three patients the preparation of the superior ophthalmic vein was performed without any complications. In two cases the fistula could be embolized completely with platinum coils. In one patient the placement of the microcatheter was impossible, because of an abnormal vascular pattern. Later on the fistula was successfully embolized by an approach via the femoral vein. All three patients had complete resolution of symptoms. There were no recurrences. CONCLUSION: Embolization of carotid-cavernous and cavernous-dural fistulas by a surgical approach via the superior ophthalmic vein represents safe and effective treatment when standard transarterial access is impossible. The cooperation of an orbital surgeon and an invasive neuroradiologist can be of benefit for this rare group of patients. SN - 0721-832X UR - https://www.unboundmedicine.com/medline/citation/11585314/Transvenous_embolization_of_carotid_cavernous_fistulas_via_the_superior_ophthalmic_vein_ L2 - https://dx.doi.org/10.1007/s004170100321 DB - PRIME DP - Unbound Medicine ER -