TY - JOUR
T1 - Endovascular embolization of recurrent traumatic carotid-cavernous fistulas managed previously with detachable balloons
AU - Luo, Chao Bao
AU - Teng, Michael Mu Huo
AU - Yen, David Hung Tsang
AU - Chang, Feng Chi
AU - Lirng, Jiing Feng
AU - Chang, Cheng Yen
PY - 2004/6
Y1 - 2004/6
N2 - 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.
AB - 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.
KW - Carotid-cavernous fistula
KW - Embolization
KW - Recurrence
UR - http://www.scopus.com/inward/record.url?scp=3142592254&partnerID=8YFLogxK
U2 - 10.1097/01.TA.0000131213.93205.57
DO - 10.1097/01.TA.0000131213.93205.57
M3 - Article
C2 - 15211128
AN - SCOPUS:3142592254
SN - 0022-5282
VL - 56
SP - 1214
EP - 1220
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 6
ER -