Traumatic scalp arteriovenous fistula post capillary implantation successfully treated using PHIL embolic agent

Abstract

Background: A traumatic arteriovenous fistula of the scalp due to hair transplantation (AVFHT) is a rare fistulous communication between branches of the arteries and draining veins in the scalp’s subcutaneous tissue. Its incidence is unknown and its clinical manifestations may range from a pulsatile mass to seldom epilepsy. Surgery and interventional approaches (percutaneous and endovascular embolization) using coils and embolic agents such as Onyx have been used as treatment options. The authors report a rare case of an AVFHT successfully treated through percutaneous and endovascular embolization using coils and precipitating hydrophobic injectable liquid (PHIL) embolic agent. This is possibly the first reported case using PHIL embolic agent to treat an AVFHT. Case Description: The patient presented with a painful and disabling scalp swelling in the right parieto-occipital region 2 years after a hair transplant in 2011. A computed tomography angiography showed an arteriovenous fistula between branches of the right superficial temporal artery and branches of the right occipital artery to the right superficial temporal vein that was successfully embolized using coils and PHIL. The patient was discharged after a smooth recovery and 1 month later remained healthy. Conclusion: Percutaneous and endovascular embolization using PHIL embolic agent can be an alternative treatment for AVFHT.

Successful Endovascular Treatment of a Traumatic Cervical Arteriovenous Fistula After a Carotid Paraganglioma Resection: A Case Report

“…Historically, AVFs were treated conservatively; later, surgery was the only method of treatment, and nowadays, endovascular treatment, when feasible, is the preferred method as it offers advantages over surgery, like less disability, less bleeding, less post-operative pain, and a faster recovery time [ 8 , 9 ]. Endovascular treatment can be performed by antegrade (arterial approach) or retrograde embolization (venous approach); the latter method is usually preferred when the vessels feeding the fistula are tortuous, difficulting the antegrade access and when the veins that drain the fistula do not contribute to the normal cerebral venous outflow, limiting the risk of a venous infarct [ 10 ].…”

Scalp Arteriovenous Fistula Following Hair Transplantation: A Rare Case Report

“…Classically, hair transplantation techniques include the excision of tiny patches of superficial skin containing hair follicles, which are subsequently transplanted into a recipient location by an incision or punch insertion [1,3]. Hair transplant surgery per se has low risk, is relatively safe, and has minimum incidence of complications [2,3,4]. The complications may be a single complaint in the form of pain, itching, dissatisfaction related to the procedure's outcome, or surgical complication in the form of infection, wound dehiscence or skin necrosis [1,5].…”

“…There was a 4.7% chance of all complications, but no scalp AVFs were recorded [3]. Scalp Arteriovenous Fistulae (AVF) is described as a direct connection between arterial scalp arteries (distal branches of STA) and draining veins that is frequently considerably dilated and lacks capillary bed juxtaposition [1,3,4]. Most traumatic scalp AVF after hair transplantation reported cases show the malformation originating from the superficial temporal artery, less commonly from the occipital artery or both.…”

“…Most traumatic scalp AVF after hair transplantation reported cases show the malformation originating from the superficial temporal artery, less commonly from the occipital artery or both. Symptoms include headache (25%), tinnitus (20%), pulsatile mass (94%), bruit and seldom epilepsy [3,4]. AVF of the scalp are quite uncommon complication of hair transplantation that is caused by direct vascular damage caused by punches, needles, and/or micro-blades [6].…”