Balloon-assisted endovascular embolization of a subcutaneous penile arteriovenous fistula using a quadruple coaxial system: A case report.

An arteriovenous fistula (AVF) is an abnormal vascular communication that allows blood to shunt directly from an artery to a vein. AVFs may be congenital or acquired, including traumatic or iatrogenic causes. Acquired AVFs typically involve the peripheral vascular system, whereas AVFs arising from the subcutaneous tissue of the penis have not been previously reported. We describe a rare subcutaneous penile AVF that was treated with endovascular therapy in a patient with a history of childhood surgery. The patient was a 49-year-old man with congenital hemophilia A and a history of circumcision during childhood. Gradual swelling in the left inguinal region had been noted for several years. Contrast-enhanced computed tomography revealed abnormal vessels extending from the left inguinal region to the left penile subcutaneous tissue, raising suspicion of an AVF. Subsequent angiography confirmed a focal direct AVF supplied by branches of the left superficial femoral artery, with early venous drainage into the left femoral vein and no diffuse nidus-like vascular network. Endovascular treatment was performed using a quadruple coaxial system incorporating a small-caliber balloon catheter. Under balloon-assisted flow control, embolization was conducted from the distal draining vein to the proximal feeding artery using a mixture of N-butyl-2-cyanoacrylate, lipiodol, and ethanol. This case suggests that endovascular treatment may be a useful option for selected superficial penile AVFs.