Direct-puncture embolization of scalp arteriovenous fistulae

We present our experience of flow control with the aid of a circular compression device (CCD) for embolization of scalp arteriovenous fistulae (sAVFs). A 21-year-old female presented with a pulsating scalp mass with sAVFs fed by the superficial temporal arteries. A CCD with a beveled circular handle and concentric hole was used to treat the condition. After the CCD was compressed over the area of the fistulae, the fistulae were punctured and blood regurgitation was assured. While maintaining flow stasis within the boundary of the CCD and loading heparinized dextrose-saline solution, a 50% mixture of N-butyl-2-cyanoacrylate and Lipiodol was applied during the compression, which was sustained for 1-2 minutes. Finally, the sAVFs were almost completely occluded without complications. Our designed CCD was effective for flow control, and direct-puncture embolization of N-butyl-2-cyanoacrylate during flow control using the CCD was safe and effective for the treatment of sAVFs.