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Transvenous balloon-protected embolization of a scalp arteriovenous fistula using Onyx liquid embolic.
MedLine Citation:
PMID:  21479581     Owner:  NLM     Status:  Publisher    
BACKGROUND: Scalp arteriovenous fistulas (AVFs) are rare and potentially complex lesions that can be treated in a multimodal fashion. We present here the first successful treatment of a Stage Ib scalp AVF using a balloon-protected, retrograde transvenous embolization with the liquid embolic Onyx. METHOD: We describe the case of a 60-year-old man with a scalp AVF that had a fine, diffuse, serpiginous arterial supply, precluding a transarterial approach, and multiple venous drainage paths, including the external jugular vein (EJV). The lesion was successfully embolized exclusively via a femoral transvenous retrograde approach using Onyx with balloon-protection of the EJV to simultaneously prevent pulmonary embolism and enable improved retrograde casting of the fistula-outflow zone. FINDINGS: The combined use of Onyx with proximal balloon-protection in a transvenous retrograde femoral approach is a novel method that can be used to definitively treat scalp AVFs with a defined catheter-accessible venous outflow. CONCLUSION: This technique may be useful when transarterial embolization, direct puncture, or surgical excision are not practical or possible.
Richard T Z Dalyai; Clemens M Schirmer; Adel M Malek
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-9
Journal Detail:
Title:  Acta neurochirurgica     Volume:  -     ISSN:  0942-0940     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Cerebrovascular and Endovascular Division, Department of Neurosurgery Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street, Proger 7, Boston, MA, 02111, USA.
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