Anatomic Variation of Facial Vein in Carotid-Cavernous Fistula and Trans-Facial Vein Embolization.
OBJECTIVE
Trans-facial vein (FV) embolization via the internal jugular vein is an alternative approach to embolization of carotid cavernous fistulas (CCFs). The purpose of this study is to report the anatomic variation of FVs and our experience of trans-FV embolization of CCFs.


METHODS
Over 6 years, 26 patients (12 men and 14 women; age range 27-72 years old) with CCFs underwent trans-FV embolization because of anterior drainage of fistulas. We retrospectively analyzed angioarchitecture of the CCFs focusing on the anatomic variations of FVs and angiographic and clinical outcomes after embolization.


RESULTS
FVs drained to the internal jugular vein in 10 (38%) cases; FVs unexpectedly emptied into the external jugular vein in 16 (62%) cases. All FVs entered into the internal jugular vein at the level of the hyoid bone. In cases with fistulas to the FV and EJV, the termination of FVs was variable including superior (n = 5), inferior (n = 1), or at the level of the hyoid bone (n = 10). Successful microcatheterization via different insertions of FVs to jugular veins was achieved in all cases. One patient had a small residual fistula, and 2 patients had fistula recurrence. Temporary impairment of cranial nerve III or VI occurred in 4 patients. The mean clinical follow-up time was 18 months.


CONCLUSIONS
Trans-FV embolization is an effective and safe method to manage CCFs with anterior drainage. However, anatomic variations of the FV exist, and a careful work-up of fistula venous drainage before trans-FV embolization is essential to reduce erroneous attempts, procedure time, and periprocedural risk.
Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; Department of Radiology, National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China; Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan, Republic of China. Electronic address: cbluo@vghtpe.gov.tw.
Chao-Bao
CB
Luo
Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; Department of Radiology, National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China.
Feng-Chi
FC
Chang
Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; Department of Radiology, National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China.
Michael Mu-Huo
MM
Teng
Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan, Republic of China.
Ta-Wei
TW
Ting
D000328:Adult; D000368:Aged; D063405:Anatomic Variation; D000792:Angiography; D020216:Carotid-Cavernous Sinus Fistula / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods; D005145:Face / Q000098:blood supply*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D014680:Veins
Carotid-cavernous fistula; Embolization; Facial vein