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Lessons learned from difficult or unsuccessful cannulations of the superior ophthalmic vein in the treatment of cavernous sinus dural fistulas.
Ophthalmology. 2006 Jul; 113(7):1220-6.O

Abstract

OBJECTIVE

Retrograde cannulation of the superior ophthalmic vein (SOV) is an important route for embolization of cavernous sinus dural fistulas (CDF). We present our experience with technically difficult cases in which it was not possible to isolate or cannulate this vein.

DESIGN

Retrospective, noncomparative, interventional case series.

PATIENTS

All patients diagnosed with dural CDF at the University of California Los Angeles Medical Center between January, 1993, and July, 2005, and who were treated with embolization via the SOV.

METHODS

The clinical records of all patients were reviewed.

MAIN OUTCOME MEASURES

Patient demographics, clinical presentation, and surgical findings.

RESULTS

Of 91 patients diagnosed with CDF during the study period, 25 patients (16 females, 9 males; mean age, 59 years) were treated with embolization via the SOV. In 6 of them (24%; 4 women and 2 men; mean age, 67 years), there were significant difficulties in cannulation of the SOV or in successful closure of the fistula with this approach. Three patients had a fragile or a very small vein that could not be cannulated, and 1 of the 3 also had a large, posteriorly located varix that bled extensively on attempted cannulation. In 2 other patients, the anterior segment of the SOV was clotted and the catheter could not be threaded. In 1 patient, an inferior location of the supraorbital vein resulted in difficulties in correct identification of the SOV.

CONCLUSIONS

Although the SOV is a useful route for CDF embolization, the presence of fragile or clotted veins can preclude successful cannulation. Deeper orbital dissections carry a higher risk of uncontrolled bleeding and should be avoided, especially in older patients with fragile veins and those with recently diagnosed high-flow fistulas.

Authors+Show Affiliations

Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-7006, USA. leiboiga15@yahoo.com.auNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

16815405

Citation

Leibovitch, Igal, et al. "Lessons Learned From Difficult or Unsuccessful Cannulations of the Superior Ophthalmic Vein in the Treatment of Cavernous Sinus Dural Fistulas." Ophthalmology, vol. 113, no. 7, 2006, pp. 1220-6.
Leibovitch I, Modjtahedi S, Duckwiler GR, et al. Lessons learned from difficult or unsuccessful cannulations of the superior ophthalmic vein in the treatment of cavernous sinus dural fistulas. Ophthalmology. 2006;113(7):1220-6.
Leibovitch, I., Modjtahedi, S., Duckwiler, G. R., & Goldberg, R. A. (2006). Lessons learned from difficult or unsuccessful cannulations of the superior ophthalmic vein in the treatment of cavernous sinus dural fistulas. Ophthalmology, 113(7), 1220-6.
Leibovitch I, et al. Lessons Learned From Difficult or Unsuccessful Cannulations of the Superior Ophthalmic Vein in the Treatment of Cavernous Sinus Dural Fistulas. Ophthalmology. 2006;113(7):1220-6. PubMed PMID: 16815405.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lessons learned from difficult or unsuccessful cannulations of the superior ophthalmic vein in the treatment of cavernous sinus dural fistulas. AU - Leibovitch,Igal, AU - Modjtahedi,Sara, AU - Duckwiler,Gary R, AU - Goldberg,Robert A, PY - 2005/12/09/received PY - 2006/02/03/revised PY - 2006/02/05/accepted PY - 2006/7/4/pubmed PY - 2006/7/21/medline PY - 2006/7/4/entrez SP - 1220 EP - 6 JF - Ophthalmology JO - Ophthalmology VL - 113 IS - 7 N2 - OBJECTIVE: Retrograde cannulation of the superior ophthalmic vein (SOV) is an important route for embolization of cavernous sinus dural fistulas (CDF). We present our experience with technically difficult cases in which it was not possible to isolate or cannulate this vein. DESIGN: Retrospective, noncomparative, interventional case series. PATIENTS: All patients diagnosed with dural CDF at the University of California Los Angeles Medical Center between January, 1993, and July, 2005, and who were treated with embolization via the SOV. METHODS: The clinical records of all patients were reviewed. MAIN OUTCOME MEASURES: Patient demographics, clinical presentation, and surgical findings. RESULTS: Of 91 patients diagnosed with CDF during the study period, 25 patients (16 females, 9 males; mean age, 59 years) were treated with embolization via the SOV. In 6 of them (24%; 4 women and 2 men; mean age, 67 years), there were significant difficulties in cannulation of the SOV or in successful closure of the fistula with this approach. Three patients had a fragile or a very small vein that could not be cannulated, and 1 of the 3 also had a large, posteriorly located varix that bled extensively on attempted cannulation. In 2 other patients, the anterior segment of the SOV was clotted and the catheter could not be threaded. In 1 patient, an inferior location of the supraorbital vein resulted in difficulties in correct identification of the SOV. CONCLUSIONS: Although the SOV is a useful route for CDF embolization, the presence of fragile or clotted veins can preclude successful cannulation. Deeper orbital dissections carry a higher risk of uncontrolled bleeding and should be avoided, especially in older patients with fragile veins and those with recently diagnosed high-flow fistulas. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/16815405/Lessons_learned_from_difficult_or_unsuccessful_cannulations_of_the_superior_ophthalmic_vein_in_the_treatment_of_cavernous_sinus_dural_fistulas_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(06)00426-X DB - PRIME DP - Unbound Medicine ER -