Intraorbital arteriovenous fistulas: illustrative case

Area of Science:

• Vascular Surgery
• Interventional Neuroradiology
• Ophthalmology

Background:

• Intraorbital arteriovenous fistulas (ioAVFs) are rare vascular shunts distinct from carotid-cavernous fistulas (CCFs).
• Optimal treatment strategies for ioAVFs remain undefined, necessitating case analysis for evidence-based management.
• Existing literature lacks consensus on the best approach for ioAVF treatment.

Purpose of the Study:

• To analyze reported cases of ioAVFs to inform clinical decision-making.
• To establish effective management strategies for intraorbital arteriovenous fistulas.
• To review treatment outcomes and complications associated with ioAVFs.

Main Methods:

• Systematic literature review of 28 ioAVF cases reported since 1978.
• Inclusion of an additional illustrative case for comprehensive analysis.
• Diagnostic workup primarily involved catheter angiography to identify feeding vessels and drainage patterns.

Main Results:

• Common symptoms include chemosis, proptosis, and headaches, mirroring CCFs.
• The ophthalmic artery (OA) is the primary feeder (96.6%), with venous drainage mainly via the superior ophthalmic vein (SOV).
• Treatment, primarily embolization (66.7%), yielded an 85.7% cure rate, though complications like hemorrhage and SOV thrombosis occurred.

Conclusions:

• Intraorbital AVFs typically feature direct OA inflow and challenging treatment pathways.
• A multimodal management approach, potentially including observation, can lead to high ioAVF cure rates.
• Transvenous embolization is the most frequent intervention; direct OA embolization poses a risk of visual deficit.