Neurointervention.  2021 Jul;16(2):194-198. 10.5469/neuroint.2021.00157.

Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistula via Radial Artery and Median Cubital Vein

• Tan WN
• Rajadurai A
• Balakrishnan D

• KMID: 2517748
• DOI: http://doi.org/10.5469/neuroint.2021.00157

Abstract

Cavernous sinus dural arteriovenous fistula (CS-DAVF) is an arteriovenous shunt where there is fistulous blood flow from the dural arteries from the internal or external carotid artery into the cavernous sinus. The current mainstay of therapy is endovascular treatment. We present a case of restrictive type of CS-DAVF in a 75-year-old male who presented with right eye symptoms. He was treated with embolisation using trans-radial artery access for angiographic runs and a median cubital vein access navigating into the cavernous sinus for coil deployment. This technique completely avoids the conventional technique of a femoral approach and confines all access to the arm. Therefore, there are less risks and complications associated with an arm access, improves patients’ comfort and mobility post procedure. Transradial artery and cubital vein access allows for a safe and convenient alternative technique using the arm as compared with conventional transfemoral approach for treatment of CS-DAVF.

Keyword

Cavernous sinus dural arteriovenous fistula; Endovascular treatment; Transradial approach; Transvenous; Median cubital vein; Embolization

Figure

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  Fig. 1. (A) Pre-operative clinical examination shows presence of right eye proptosis, chemosis, and subconjunctival hemorrhage. The (B) shows upper limb arterial and venous access for transvenous embolization. Trans-radial artery access by puncture of the right radial artery (arrow) and transvenous access by puncture of the right median cubital vein (arrowhead). (C, D) 5 Fr Sims 2 catheter (Merit Medical, South Jordan, UT, USA) within the right internal carotid artery for angiographic runs (arrows). Tip of vertebral catheter at the right facial vein (arrowhead) and microcatheter further navigate into right superior ophthalmic vein and cavernous sinus (dashed arrow) with coils (asterisk) within. (E, F) Digital subtraction angiography of right internal carotid artery (ICA) in lateral view. (E) Pre embolization image shows early filling of contrast media into the cavernous sinus and superior ophthalmic vein from meningohypophyseal branches of right ICA. (F) Post embolization, coils seen within the cavernous sinus and no abnormal flow into the cavernous sinus or superior ophthalmic vein.

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