[Congenital arteriovenous facial fistula cured by percutaneous embolization]

Arteriovenous fistulas of the external carotid artery are uncommon. They are usually of traumatic origin but in rare cases may be congenital. When located in regions with difficult access, they constitute a difficult surgical problem because of intra-operative bleeding and significant morbidity. With the advent of transcatheter embolization and new embolic agents, embolization has become the treatment of choice, with a cure rate of over 95%, low morbidity and brief hospitalization. Occlusion of the fistula itself, rather than occlusion of feeding pedicles, is achieved by super-selective catheterization and the use of a suitable permanent embolic agent, depending on location of the fistula and its flow characteristics. A girl aged 2 10/12 with a large, high-flow, arteriovenous fistula of the internal maxillary artery is presented. Complete occlusion of the fistula itself, with full cure, was achieved by super-selective transcatheter embolization using Gianturco coils. There has been no recurrence after more than 7 months of follow-up.