Abstract
Objective: We report a case of anterior condylar confluence (ACC) dural arteriovenous fistula (DAVF) with ocular symptoms cured with transvenous embolization via the facial vein.
Case Presentation: The patient was a 52-year-old man who had pulsatile tinnitus 5 years ago that cured spontaneously. He had developed conjunctival hyperemia, exophthalmos, and diplopia 1 month before admission. Magnetic resonance angiography and digital subtraction angiography showed the shunt point was the ACC, and the main venous drainage route was retrograde from the cavernous sinus to the superior orbital vein due to obstruction of the antegrade drainage route. We performed transvenous embolization by re-opening channels from the internal jugular vein to the ACC, but it failed. Then, we tried the trans-facial vein approach. The triple coaxial catheter system consisted of a 6-Fr guiding catheter, a 4-Fr intermediate catheter, and a micro-catheter that allowed us to use a long distance approach to the ACC with good supporting force. We successfully performed transvenous coil embolization via the facial vein, and the patient's ocular symptoms improved immediately.
Conclusion: Transvenous embolization via the facial vein using the triple coaxial catheter system will be useful for similar ACC DAVF cases.
