Neurointervention.  2022 Mar;17(1):50-53. 10.5469/neuroint.2021.00276.

Snowballing Technique for High Flow Arteriovenous Fistula: A Technical Note

• Alokaili RN
• Alokaili HR
• Badran MF
• Aldahash HA
• Binkhamis SM

• KMID: 2526626
• DOI: http://doi.org/10.5469/neuroint.2021.00276

Abstract

A novel endovascular technique to occlude high flow direct arteriovenous fistulae is presented, where the distal tip of the microcatheter acts as a nucleus that the operator can grow a plug from a liquid embolic agent. Its advantages (such as cost-saving and distal reachability), disadvantages (such as embolic material instability), and technique are discussed.

Keyword

Endovascular technique; Arteriovenous fistula; Interventional radiology

Figure

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  Fig. 1. Describing radiography obtained during a ‘snowballing procedure’ for arteriovenous fistula. (A) Lateral view of the right internal carotid angiogram. A direct fistula connects a hypertrophied feeding artery (white arrow) to a hypertrophied draining vein (black arrow). (B) Pre-embolization lateral view of a super-selective left anterior cerebral artery feeder angiographic run illustrating a direct fistula. (C) Lateral fluoroscopic roadmap image of initial embolic agent aggregate hanging on the tip of the microcatheter (black arrow). Embolic agent in the jugular bulb from prior standard technique (white arrow). (D) Intermittent lateral subtracted fluoroscopic images with 20-second separation between each spot image with a right to left time course of earlier to later, showing incremental growth of the embolic agent snowball at the tip of the microcatheter (black arrows).

Reference

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