Percutaneous Treatment of Scalp Arteriovenous Fistulas by Direct Puncture and Polydocanol Sclerotherapy

Excerpt

Scalp arteriovenous fistulas (AVFs) are anomalous connections between the scalp arteries and veins without involvement of the capillary vessels. Most of these rare lesions occur secondary to trauma or iatrogenic injury [1, 2]. The superficial temporal artery is particularly vulnerable to trauma due to its long and subcutaneous course. Scalp AVFs generally present with small subcutaneous pulsatile swelling in the beginning, which enlarges and causes cosmetic problems over time. The mainstay of treatment consists of surgical excision, which combined with embolization is usually performed either by a transcatheter route or direct percutaneous puncture [3‐7]. The typical endovascular treatment technique depends on the obliteration of arteriovenous connection with permanent embolic agents, such as glue, Onyx or coils [2, 4]. Alternatively, a successful treatment with direct percutaneous puncture and sclerotherapy with sodium tetradecyl sulfate has also been reported [8]. In this report, we describe the successful percutaneous treatment of two cases of high-flow scalp AVFs by direct puncture and polydocanol foam sclerotherapy and a 4‑year follow-up. …