Journal of neuroendovascular therapy · 2026
Stepwise Incisionless Percutaneous Flow-Control Treatment of a High-Flow Scalp Arteriovenous Fistula with a Large Superficial Venous Pouch: A Case Report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Ueno Tomoki, Uchimura Masahiro, Eda Hirotake, Kimura Yoriyoshi, Hayashi Kentaro
Аннотация
OBJECTIVE: Scalp arteriovenous fistulas (AVFs) with multiple tortuous superficial feeders and a large venous pouch can require meticulous flow control during treatment. Open surgical excision may be associated with blood loss, wound-healing problems, and cosmetic concerns, whereas percutaneous liquid embolization of a high-flow superficial shunt carries a risk of nontarget migration and scalp necrosis. We report an incisionless, stepwise percutaneous flow-control strategy for such a lesion.
CASE PRESENTATION: A man in his 50s presented with a progressively enlarging, pulsatile right temporal mass, pulsatile tinnitus, and visual fatigue 30 years after head trauma. DSA revealed a high-flow scalp AVF supplied by the right superficial temporal artery (STA), the right occipital artery, and the contralateral STA, draining through a 2.5-cm superficial venous pouch; the lesion corresponded to Cho-Do type II and Yakes type IIb. We performed a stepwise percutaneous intervention. First, we injected epinephrine-containing lidocaine around the pouch to constrict distal feeding arteries. Second, we punctured the primary draining vein and deployed microcoils to establish a mechanical scaffold. Third, under circumferential compression, we sequentially injected 25% and 30% n-butyl cyanoacrylate-Lipiodol (Guerbet, Villepinte, France) mixtures via direct puncture to obliterate the posterior and anterior compartments. Finally, we occluded the residual STA feeder using ultrasound-guided percutaneous suture ligation. The patient experienced no ischemic cutaneous complications. DSA at 12 months confirmed complete AVF obliteration.
CONCLUSION: In selected superficial scalp AVFs, combining pharmacological inflow reduction, direct-puncture coil scaffolding, circumferential compression, and ultrasound-guided percutaneous suture ligation may provide a less invasive alternative to open resection.
CASE PRESENTATION: A man in his 50s presented with a progressively enlarging, pulsatile right temporal mass, pulsatile tinnitus, and visual fatigue 30 years after head trauma. DSA revealed a high-flow scalp AVF supplied by the right superficial temporal artery (STA), the right occipital artery, and the contralateral STA, draining through a 2.5-cm superficial venous pouch; the lesion corresponded to Cho-Do type II and Yakes type IIb. We performed a stepwise percutaneous intervention. First, we injected epinephrine-containing lidocaine around the pouch to constrict distal feeding arteries. Second, we punctured the primary draining vein and deployed microcoils to establish a mechanical scaffold. Third, under circumferential compression, we sequentially injected 25% and 30% n-butyl cyanoacrylate-Lipiodol (Guerbet, Villepinte, France) mixtures via direct puncture to obliterate the posterior and anterior compartments. Finally, we occluded the residual STA feeder using ultrasound-guided percutaneous suture ligation. The patient experienced no ischemic cutaneous complications. DSA at 12 months confirmed complete AVF obliteration.
CONCLUSION: In selected superficial scalp AVFs, combining pharmacological inflow reduction, direct-puncture coil scaffolding, circumferential compression, and ultrasound-guided percutaneous suture ligation may provide a less invasive alternative to open resection.