Endovascular treatment of post-traumatic complex carotid-cavernous fistulas, using the arterial approach

Endoarterial embolization is now the treatment of choice for traumatic carotid-cavernous fistulas. However, traumatic or surgical occlusion of the carotid artery, or special cases such as unilateral double carotid-cavernous fistula, can make the transarterial approach hazardous or impossible. In such cases transvenous embolization can be an alternative treatment, although it is sometimes difficult or impossible to perform. Three cases of direct traumatic carotid-cavernous fistula and their treatments are described. In the first case, unilateral double carotid-cavernous fistula was treated with detachable balloons. In the second case, the fistula had previously been treated by trapping; percutaneous angioplasty was performed with subsequent plastic embolization of the fistula. In the third case, transarterial and transvenous approaches were impossible, and the patient was cured by combining a surgical procedure and an interventional technique.