1Karthikeyan Muthugounder Athiyappan, 1Mathew Cherian, 1Pankaj Mehta, 1Santhosh Poyyamoli, 1Nikhil Handihal Reddy, 1Akhil Monga

1Kovai Medical Centre, Coimbatore, India

 

Case Report:

Intra-orbital arteriovenous fistulae (AVF) are very rare and can have signs and symptoms similar to carotico-cavernous fistula which needs to be differentiated accurately for appropriate treatment. Intra orbital AVF is commonly treated by embolization through a transarterial or transvenous approach. Central retinal artery occlusion is a fearsome complication of transarterial approach and needs meticulous planning. Here we describe percutaneous embolization of an orbital AVF in view of difficult anatomical access.

Material(s) and Method(s):

A 67 year old female who is a known diabetic and hypertensive came to us with complaints of chemosis, proptosis of the left eye for one year. She was diagnosed as superior ophthalmic vein thrombosis elsewhere based on MR imaging and was treated with anticoagulation with no clinical improvement. She underwent digital subtraction angiography (DSA) which showed left orbital AVF fed by distal left ophthalmic artery branches draining into partially thrombosed left superior ophthalmic vein posteriorly and through facial vein anteriorly. She had a tortuous arterial and venous anatomy for access into the fistula. Ultrasound orbit showed the fistula sac in the superolateral portion of the orbit and was directly punctured using a 22g scalp vein. The needle location within the fistula was confirmed through left common carotid angiogram and direct injection from the scalp vein needle. The fistula was embolized using a 20 % glue-lipiodol mixture under the roadmap achieving complete obliteration.

Results:

Her chemosis, proptosis and eye congestion improved to near normal appearance of the eye over a period of two weeks.

Conclusion:

1. Intraorbital AVF is a close mimicker of carotico-cavernous fistula which needs accurate diagnosis through DSA for appropriate treatment planning.

2. Percutanenous embolization of orbital AVF is a safe and simple alternative to traditional transarterial or venous approach.