title: Blind endovascular catheterization and direct access of an occluded superior ophthalmic vein for treatment of carotid cavernous fistula.
abstract: We describe a case of an elderly patient who presented with right-sided ophthalmoplegia, proptosis, chemosis, and increased intraocular pressure. An angiogram showed feeding vessels from the bilateral internal and external carotid arteries. Our initial attempt to blindly probe the inferior petrosal sinus was unsuccessful. This was followed by a right anterior orbitotomy exposing the superior ophthalmic vein which was directly cannulated with an 18 gauge angiocatheter. However, a proximal third of the superior ophthalmic vein within the orbit which was thrombosed was probed blindly. The thrombosed vein was cannulated with a microcatheter to obtain coil embolization of the carotid cavernous fistula. The implications of the procedure are discussed, given that, to our knowledge, such an endeavor has never been performed.
authors.affiliation: Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Alaraj
authors.forename: Bobby
authors.initials: B
authors.lastname: Kim
authors.forename: Gerald
authors.initials: G
authors.lastname: Oh
authors.forename: Victor
authors.initials: V
authors.lastname: Aletich
mesh_terms: D000368:Aged; D000792:Angiography; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005123:Eye / Q000098:blood supply*; D006801:Humans; D062666:Vascular Access Devices
keywords: Fistula; Intervention; Stenosis; Vein; guidewire