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Transvenous Sonographically Guided Percutaneous Access for Treatment of an Indirect Carotid Cavernous Fistula

Turgut Berkmena, Neil A. Troffkina and Ajay K. Wakhlooa

a From the Section of Neuroendovascular Surgery and Interventional Neuroradiology, Departments of Radiology and Neurological Surgery, University of Miami School of Medicine, Miami, Florida



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  		FIG 1. A, Selective right internal carotid arteriogram (frontal view) shows an indirect right CCF with flow through the circular sinus (arrow) cross-filling the left cavernous sinus (arrowheads). There are coils within the right cavernous sinus from an embolization previously attempted at another institution. B, Later phase of the same injection. A large left SOV is opacified (arrow). C and D, On later phase images (C, frontal view; D, lateral view), the left SOV drains toward the left angular and facial veins (arrows). The left facial vein terminates in small collateral channels (arrowheads) and does not directly communicate to the jugular venous system.



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  		FIG 2. A, The 4F sheath is placed percutaneously inside the left facial vein. Note that the puncture site is well inferior to the left orbit. B, Catheterization of the left SOV (lateral view)



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  		FIG 3. Early- (A) and late-phase (B) images from a right internal carotid injection following embolization with NBCA and GDC. The coil within the left SOV is depicted (arrows), and a completely obliterated CCF can be seen.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X