Endovascular Treatment of Scalp Arteriovenous Fistula: a case report and systematic review of the literature

Resumo

Introdução: A fístula arteriovenosa (FAV) do couro cabeludo, também conhecida como aneurisma cirsoide, representa uma patologia vascular rara, caracterizada por conexões anômalas entre artérias e veias no couro cabeludo. A abordagem endovascular para o tratamento oferece vantagens em termos de precisão, menor morbidade e desfechos clínicos favoráveis em comparação com as intervenções cirúrgicas tradicionais. Foi realizada uma revisão sistemática da literatura com o objetivo de examinar casos semelhantes, com ênfase na classificação diagnóstica e nas estratégias de manejo. Relato de Caso: Um adulto jovem desenvolveu uma FAV do couro cabeludo após trauma por bala de borracha, confirmado por imagem angiográfica. O paciente foi submetido a uma intervenção endovascular transarterial com o objetivo de ocluir a fístula. O tratamento endovascular resultou em alívio sintomático rápido e oclusão completa da FAV, conforme verificado por exames de imagem de seguimento. A revisão sistemática incluiu 42 pacientes de 14 estudos, abrangendo todos os tipos de fístulas arteriovenosas do couro cabeludo. Esses casos apresentavam ramos exclusivamente da artéria carótida externa como fontes de irrigação, com drenagem venosa para veias do couro cabeludo. Todas as fístulas foram classificadas de acordo com a classificação de Yokouchi. Diversas técnicas endovasculares foram utilizadas, incluindo uso de molas, n-butil cianoacrilato (NBCA), copolímero de etileno vinil álcool (EVOH) e partículas, aplicadas por via transarterial, transvenosa ou por punção direta. Em dois casos, foi necessário um segundo procedimento endovascular para obter a oclusão completa da fístula. Conclusão: Este caso ressalta as vantagens da técnica endovascular no manejo das fístulas arteriovenosas do couro cabeludo, incluindo menor tempo de recuperação e redução dos riscos do procedimento. A revisão sistemática demonstrou uma variedade de abordagens endovasculares, todas com sucesso na oclusão completa da fístula, reforçando a eficácia dessa modalidade terapêutica para o tratamento das FAVs do couro cabeludo.

Palavras-chave

Fístula arteriovenosa; FAV do couro cabeludo; Tratamento endovascular; Radiologia intervencionista; Aneurisma cirsoide

Abstract

Background: Scalp arteriovenous fistula (AVF), commonly referred to as a cirsoid aneurysm, represents an uncommon vascular pathology characterized by abnormal arteriovenous connections within the scalp. Endovascular approach for treatment offers advantages in terms of precision, reduced morbidity, and favorable clinical outcomes when compared to traditional surgical interventions. A systematic review was conducted to examine similar cases, emphasizing diagnostic classification and management strategies. Case presentation: A young adult developed a scalp AVF after rubber bullet trauma, confirmed by angiographic imaging. The patient underwent a transarterial endovascular intervention aimed at occluding the fistula. Endovascular treatment led to rapid symptom relief and complete occlusion of the scalp AVF, as verified by follow-up imaging. The systematic review analyzed 42 patients from 14 studies, encompassing all types of scalp arteriovenous fistulae. These cases were characterized by exclusively external carotid artery feeders and scalp vein drainage. All cases were classified according to the Yokouchi classification. A variety of endovascular techniques were employed, including the use of coils, n-butyl cyanoacrylate (NBCA), ethylene vinyl alcohol copolymer (EVOH), and particles, applied via transarterial, transvenous, or direct puncture approaches. In two cases, a second endovascular procedure was required to achieve complete obliteration of the fistula. Conclusion: This case highlights the advantages of the endovascular technique in managing scalp arteriovenous fistulas (AVFs), including reduced recovery time and minimized procedural risks. The systematic review demonstrated a variety of endovascular approaches, all achieving complete obliteration of the fistula, further reinforcing the efficacy of this treatment modality for managing scalp AVFs.

Keywords

Arteriovenous fistula; Scalp AVF; Endovascular treatment; Interventional radiology; Cirsoid aneurysm

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