Carotid-cavernous fistulas: embolization through the superior ophthalmic vein approach

Five patients aged 17-33 years with traumatic carotid-cavernous fistulas (CCFs) were treated by antegrade embolization through a superior ophthalmic vein approach, using cutdown technique on the upper eyelid. CCFs had recurred after prior treatment by multivessel ligation in three patients. Embolization through the ophthalmic vein resulted in long-term cure in three patients. The remaining patients were successfully treated by embolization through the arterial approach after failure of the ophthalmic vein technique. This is a new and rewarding technique to treat patients with CCFs, especially when there has been carotid ligation, provided the ophthalmic vein is thickened and arterialized.