Transvenous embolization for a purely intraorbital arteriovenous fistula

Abstract

Purely intraorbital arteriovenous fistulas (AVFs) are rare, and their clinical management is controversial. The authors successfully treated a patient with an intraorbital AVF by transvenous embolization alone. An accurate distinction between an arteriovenous malformation (AVM), which is characterized by the existence of a nidus, and an AVF, which has no nidus, is important and requires superselective ophthalmic artery angiography. Treatment of an intraorbital AVF by transvenous embolization can improve visual function.

Transvenous Coil Embolization for Dural Arteriovenous Fistulas of the Ophthalmic Sheath: Report of Two Cases and Review of the Literature

“…Recently, surgical removal of the dAVF and transvenous embolization were used to manage the dAVF. Direct surgical removal or obliteration by means of a frontoorbital approach fully restored vision and corrected proptosis 4)5)6). No evidence of recurrence of dAVFs has been found in previous surgical cases 5)10).…”

“…Therefore, surgical treatment is an effective treatment method, but it is invasive and there are also case-specific risks. Direct surgical removal may be very difficult because of the presence of intraorbital fat, which can obscure structures and is consequently associated with a high risk of hemorrhage 4). A few reports concerning intraorbital dAVFs have advocated transvenous embolization, and some clinicians recommend this as the first choice when treating intracranial dAVFs.…”

“…To the best of our knowledge, fewer than 20 cases have been reported in the literature 1)2)3)4)5)6)7)8)9)10)11). Because of the small number of reported cases, diagnosis is difficult and treatment methods are controversial 11).…”

Transvenous Coil Embolization of an Intraorbital Arteriovenous Fistula

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] The clinical presentation of an intraorbital AVF is indistinguishable from that of a CCF with predominantly ocular findings. These patients manifest with symptoms related to ocular venous congestion, including chemosis, exophthalmos, loss of visual acuity, and extraocular motor paresis.…”

Venous Procedures

“…12) Occasionally, a true intraorbital fi stula may mimic a cavernous dural fi stula clinically; even the angiographic studies may create the appearance of a cavernous dAVF if it drains both posteriorly toward the cavernous sinus and anteriorly to the SOV. a) These intraorbital fi stulas are successfully treated by transvenous embolization 70,71 provided the site of the fi stula is accurately determined. b) Orbital fi stulas may connect directly to the SOV, so coils must be placed in that vessel at the site of the fi stula, rather than in the cavernous sinus, as is usually done in cavernous dAVFs.…”