Abstract / Summary
Introduction: Intraorbital arteriovenous fistula (IOAVF) is a rare vascular anomaly characterized by a direct arteriovenous shunt within the orbit, often presenting with orbital congestion, proptosis, and ocular pain. Fewer than 50 cases have been documented in the literature. Unlike carotid-cavernous fistulas, IOAVFs are supplied by branches of the ophthalmic and internal maxillary arteries, draining through orbital veins into the facial vein without direct cavernous sinus involvement. Accurate diagnosis through digital subtraction angiography (DSA) is essential for treatment planning, as noninvasive imaging may miss the subtle intraorbital shunt. Case Presentation: A 60-year-old woman presented with progressive right eye proptosis, conjunctival congestion, and ocular pain. DSA confirmed a right IOAVF fed by branches of the ophthalmic and internal maxillary arteries, draining into the facial vein via dilated ophthalmic veins. The patient underwent a transvenous endovascular approach: a microcatheter was navigated through the facial and ophthalmic veins to the fistula site, where five detachable coils (Numen™ Silk coils; MicroPort NeuroTech, Shanghai, China) were deployed, followed by 0.5 mL of Squid 18 liquid embolic agent (Balt Extrusion, Montmorency, France). The combined coil-liquid technique achieved complete occlusion of the fistula in a single session. The patient’s symptoms resolved, vision improved, and follow-up imaging showed no residual shunt. Conclusion: This case demonstrates the efficacy of a tailored transvenous embolization strategy using coils and Squid 18 in the definitive treatment of IOAVFs. This approach provides an effective, minimally invasive treatment for IOAVF and highlights the importance of timely diagnosis and individualized treatment strategies.