Arteriovenous fistula at scalp: rapid progression after embolization of contralateral facial arteriovenous fistula.

Abstract

Arteriovenous fistula at scalp : rapid progression after embolization of contralateral facial arteriovenous fistula

Purpose : To demonstrate the hemodynamic relationship between the two arteriovenous fistulas (AVF) located at anatomically different regions.

Summary of case : A 57-year-old man admitted with a 2-month history of tinnitus in the left ear. Digital subtraction angiogram revealed AVFs at left preauricular region (fed by superficial temporal artery) and right frontal scalp (fed by middle meningeal artery). Because left one was symptomatic and had much higher flow on angiogram, transarterial embolization was performed at the left superficial temporal artery with NBCA and coils to reduce shunt flow. Follow-up angiogram after 1 month showed significant change of AVF in the right frontal scalp, which were gaining another feeding artery (superficial temporal artery), remarkably increased shunt flow and change of venous drainage course (from anterior direction to posterior direction). Transarterial embolization of this AVF was performed with NBCA.

Conclusion : The hemodynamics of facial AVF can be affected by manipulation of another facial AVF located at anatomically different regions.