Abstract 208: BIUXX

Introduction Efficacy of transvenous endovascular complete embolisation of the superior ophthalmic vein (SOV) through external jugular venous approach in cranial and extra cranial arterio venous malformations. Methods Tranvenous endovascular embolisation of the superior ophthalmic vein was done in the following 3 patients. First patient, 40yr male had sudden onset right sided rapidly progressing proptosis and eye redness following a bout of cough during bronchoscopy for evaluation of a lung mass. Immediate CECT imaging brain and orbit showed phleboliths in a slow flow vascular malformation with rupture in the intra conal space with venous drainage into the SOV. No definite arterial feeders were identified. Second patient, 50 yr old lady, had gradually progressive right sided proptosis with peri orbital pain and eye redness over a period of 5 months. CECT brain and orbit showed indirect carotico cavernous fistula (CCF Barrow type B) with dilated right SOV. Third patient, 38yr old male, had a slowly progressive left sided peri orbital tortous swelling and mild proptosis over a period of 3 months following forehead trauma. CECT brain and face showed left frontal scalp and peri orbital arterio venous fistula with feeders from the superficial temporal artery and ophthalmic artery with venous drainage into the dilated SOV, facial vein and superficial temporal vein opening into the external jugular vein. Feeder from the superficial temporal artery was initially embolised from the arterial side in this patient followed by embolisation of the SOV through the trans venous approach. In all the 3 patients, SOV was the main or one of the major draining vein of the vascular malformations causing the orbital symptoms. In all the 3 patients, under general anaesthesia, USG guided access was taken from the ipsilateral external jugular vein with a 5F radial slender sheath. SOV was reached with a 2.4F microcatheter and 0.014 wire combinations manoeuvring the catheter via the facial vein and angular vein. Complete SOV embolisation was done using coils or glue mixed with lipiodol in1:1 ratio. Arterial access (Common femoral artery) was taken only in two patients. One with indirect CCF and another with left frontal arterio venous fistula to indentify the filling of the SOV in the former and to embolise the arterial feeders from the superficial temporal artery in the latter. Results Each of the 3 patients successfully underwent SOV embolisation via the trans venous approach. All the 3 patients had progressive decrease in proptosis and eye congestion in immediate post procedure period and follow up till now. Conclusions Endovascular trans venous SOV embolisation is simple and effective technique in treating indirect CCF, slow flow orbital venous malformations and extra cranial arterio venous fistula. This backdoor approach is also effective in cases where in there is no definite identifiable arterial feeder to the vascular malformation or when the feeder is a very tiny artery (ophthalmic artery) with difficult cannulation.