Embolization of Scalp AVF

Abstract

<jats:p> We report scalp arteriovenous fistulas (AVFs) in which we performed embolization and examine the treatment method. The subjects were four cases of scalp AVF treated by embolization. All cases were male and three had a past history of scalp injury. As the feeding artery, we found a single artery in one case and multiple arteries in three cases. In three cases we employed a transarterial approach by cutting down the scalp and embolized the fistula with NBCA (N-butyl-cyanoacrylate). </jats:p><jats:p> We conducted the embolization procedure as follows in order to securely occlude the fistula; 1) we obtained the precise location of fistula by the superselective angiography; 2) we induced the tip of microcatheter to immediately in front of fistula; 3) when high flow shunt was manifested, we controlled the flow by retaining the balloon catheter in the external carotid artery; 4) and injected NBCA by compressing around the fistula from above the scalp with a cylindrical instrument to prevent the migration of embolic material to the venous side. </jats:p><jats:p> As a result, all cases were completely cured and there was no major complication except for transient postoperative pain. If the transfemoral approach to fistula is impossible, it is considered effective to cut down near the fistula and embolize the scalp AVF by direct puncture to the feeding artery with NBCA as embolic material. </jats:p>

Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition

“…In particular, NBCA is a useful embolic material in the following situations: (a) cases in which pseudoaneurysms cannot be embolized via selective catheterization using the isolation technique; (b) embolization involving the preservation of the parent artery [56,134,149,163,167,174,183]; (c) cases in which coil embolization might be unsuitable because of the condition of the target vessels, e.g., those involving markedly tortuous, stenotic, or fine vessels [54,72,87,135,138,165]; (d) cases involving patients in a hypocoagulable state (refer to CQ6). Furthermore, vascular embolization with NBCA has also been reported to be useful for nasal bleeding [103,104], hemoptysis [16,141], and gastrointestinal bleeding.…”

The usefulness of temporary balloon occlusion during transarterial embolization for scalp arteriovenous fistula

“…ey can be managed by surgical excision only, endovascular embolization only, or a combination of both. [2][3][4][5][6][7][8][9][10] To treat appropriately, the understanding of vascular structure is essential. For the diagnosis, conventional DSA, threedimensional DSA, CTA, and MRI are performed.…”

“…Yokouchi et al classified sAVFs to three types in the way of treatment. [10] Type A scalp AVFs as having a single fistula fed by a single proximal feeding artery, type B AVFs as having a single fistula fed by multiple arterial feeders, and type C AVFs as having multiple fistulas with plexiform feeding arteries and a main dilated draining vein. e recommendation of treatment was that type A was initiated by TAE, type B by TVE, and type C by a combination of surgical excision and endovascular embolization.…”

“…[8] Treatment includes surgical excision, endovascular embolization, or a combination of these treatments. [2][3][4][5][6][7][8][9][10] Embolization has become more common, and transarterial or transvenous approach is selected. To treat appropriately, an understanding of the vascular structure is essential.…”

Endovascular treatment of scalp cirsoid aneurysms

“…[3] Yokouchi et al classified scalp arteriovenous fistulae into three types: Type A: has a single fistulous connection from the proximal portion of the artery, Type B: has a single fistulous connection but from multiple distal portions of the arteries and Type C: where there are multiple fistulae constituting the plexiform feeding type. [24] Sometimes the drainage can be intracranial with an associated cerebral arteriovenous malformation. [25] The diagnosis of scalp cirsoid aneurysm and its differentiation from sinus pericranii can be difficult and some confusion between the two types of lesions exists in the literature.…”