Successful treatment of direct carotid–cavernous fistula in a patient with Ehlers–Danlos syndrome type IV without arterial puncture: the transvenous triple-overlay embolization (TAILOREd) technique

Abstract

We report successful transvenous treatment of direct carotid-cavernous fistula in a patient with Ehlers-Danlos syndrome type IV using a novel triple-overlay embolization (TAILOREd) technique without the need for arterial puncture, which is known to be highly risky in this patient group. The TAILOREd technique allowed for successful treatment using preoperative MR angiography as a three-dimensional overlay roadmap combined with cone beam CT and live fluoroscopy, precluding the need for an arterial puncture.

A multi-institutional experience in the aortic and arterial pathology in individuals with genetically confirmed vascular Ehlers-Danlos syndrome

“…This finding confirms previous reports; a referral to a neurointerventionalist is recommended in these cases. 21,22 Although we did not find a consistent approach for embolization in these cases, the transvenous approach seems to offer a decreased risk of vascular injury. 21,22 Iliac arteries dissections without thrombosis can be managed medically, whereas aneurysm repairs are based on association with an AAA.…”

“…21,22 Although we did not find a consistent approach for embolization in these cases, the transvenous approach seems to offer a decreased risk of vascular injury. 21,22 Iliac arteries dissections without thrombosis can be managed medically, whereas aneurysm repairs are based on association with an AAA. Endovascular stenting of an aneurysmal iliac artery has been reported to be successful.…”