Endovascular treatment of the post-traumatic superficial temporal artery - High flow fistula of the superficial temporal vein

Patient

• The male patient is only 7-year-old
• No previous medical history
• Developed pulsatile bruit over the right preauricular region after 1 month of facial trauma
• A high flow STA -STV fistula was diagnosed with Doppler ultrasound

Grey scale

Venous / arterial / at fistula site

R- ECA Lateral

R-CCA Frontal

• Selective R-ECA lateral projection showing fistula hole
• No intracranial contribution

L-ECA

R-VA

L-ICA

• Catheterization of right STA
• Navigation of microcatheter under roadmap up to fistula hole
• Histoacryl injection via microcatheter
• Mixture of 70 % glue and lipoïdol

Roadmap

R-CCA & R-ECA control angiogram 

Device Selection

• Introducer sheath 4Fr
• Diagnostic catheter 4Fr
• Microcatheter Progreat 2.7 Fr
• Liquid embolic agent – Lipiodol diluted to 70 % glue

Doppler D1 post-embolization

The patient was discharged at D2 without any complications.

Take-home message

When treating fistulas such as this, it is mandatory to occlude the fistula site and its relevant arterial supply. A simple occlusion of the superficial temporal artery branch proximal to the fistula site will not suffice, as there will be persistent retrograde flow in the superficial temporal artery branch distal to the fistula site that still supplies the fistula. This  traumatic fistula was treated with an endovascular approach, using a mixture of histoacryl and lipiodol occluding the superficial temporal artery proximal and distal to the fistula site, as well as the drainage vein.