Conservative management of spontaneous intraorbital arteriovenous fistulas

Michael J. Sharpless, Timothy J. Sullivan, Kate Mahady

Meeting:  2022 RANZCO


Date:      -


Session Time:      -

Purpose: To report on a case of spontaneous intraorbital arteriovenous fistulas (AVF) treated with non operative management.

Method: A case report of a spontaneous intraorbital AVF diagnosed with magnetic resonance imaging (MRI) and digital subtraction angiography (DSA).

Results: A 78-year-old woman presented with a four-month history of left eye periorbital oedema, proptosis, diplopia and blurred vision. There was no history of trauma or vascular abnormalities. Digital subtraction angiography of the carotid circulation showed arteriovenous shunting at the superior medial aspect of left orbit, from meningeal branches of the ophthalmic artery into the partially thrombosed superior ophthalmic vein. Immediate surgical intervention through transvenous embolization was with- held given the high risk for intra-operative stroke or blind- ness. Over a period of six months the patient’s vision and symptoms improved with conservative management.

Conclusion: Spontaneous intraorbital arteriovenous fistulas are a very rare phenomenon that are typically difficult to treat. However, most documented cases suggest that patients typically go blind in the affected eye unless surgical intervention is done. Transvenous endovascular embolization is the most commonly used approach, how- ever it comes at significant intra-operative risk. This is the second know case of spontaneous resolution of an intraorbital AVF and further highlights the potential for non-surgical management for a selection of patients with intraorbital AVF.