Custom-made donut technique: An innovative approach to treating scalp arteriovenous fistula

Scalp arteriovenous fistulas are rare, high-flow vascular anomalies, often of post-traumatic origin. Their management remains a subject of debate owing to the limited number of reported cases. This study presents a novel approach for the treatment of a post-traumatic right mastoid scalp arteriovenous fistula in a patient with a history of multiple unsuccessful treatments. A customized, in-house three-dimensional-printed device, designed in a donut shape, was used to enhance the precision of direct puncture embolization. This approach aimed to confine embolization exclusively to the fistula site, minimizing the risk of inadvertent occlusion of adjacent vessels and subsequent cutaneous necrosis. The treatment strategy combined endovascular embolization using precipitating hydrophobic injectable liquid with surgical resection in a single-stage procedure. The intervention was completed without intraoperative or postoperative complications. Follow-up assessments confirmed complete fistula occlusion with no recurrence and satisfactory functional and aesthetic outcomes. This innovative technique highlights the potential advantages of patient-specific three-dimensional-printed devices in optimizing embolization strategies for complex vascular malformations.