Endovascular embolization of recurrent traumatic carotid-cavernous fistulas managed previously with detachable balloons

Chao Bao Luo*, Michael Mu Huo Teng, David Hung Tsang Yen, Feng Chi Chang, Jiing Feng Lirng, Cheng Yen Chang

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

61 Scopus citations

Abstract

Background: This study investigated the causes of recurrent traumatic carotid-cavernous fistulas (RTCCFs) after detachable balloon embolization and evaluated the selection of embolic materials for endovascular treatment of the RTCCFs. Methods: Over a 10-year period, 116 patients underwent transarterial balloon embolization with occlusion of the fistulas and preservation of the parent arteries. In 15 patients, 18 RTCCFs developed. The causes of RTCCFs included premature balloon deflation and migration (n = 13) or bony fragment puncture of balloons (n = 5). A second or third embolization involved balloons (n = 6), balloons with coils (n = 2), and N-butyl-2-cyanoacrylate with coils (n = 7), or balloon, coils, and N-butyl-2-cyanoacrylate (n = 3). Results: In this study, 17 RTCCFs were successfully occluded after repeat embolization with preservation of parent arteries. One case resulted in recurrent epistaxis. The recurrent fistula and parent artery were occluded with balloons. No significant complications or recurrent fistulas occurred after the last embolization (mean follow-up period, 16 months). Conclusions: Balloon puncture or premature deflation and migration occasionally cause RTCCFs. Sacrifice of the parent artery rarely is needed. Transarterial embolization remains the best approach, with balloons used first, then coils, N-butyl-2-cyanoacrylate, or both.

Original languageEnglish
Pages (from-to)1214-1220
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume56
Issue number6
DOIs
StatePublished - Jun 2004

Keywords

  • Carotid-cavernous fistula
  • Embolization
  • Recurrence

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