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Abstract: This article describes a 68-year-old man who presented to the outpatient clinic with a complaint of redness and swelling in the left eye for 1 year, which had been aggravated for 3 months. The patient underwent a total cerebral arteriogram 2 weeks ago at an outside hospital and was diagnosed with arteriovenous fistula, and was admitted for further surgical treatment. The patient was admitted to the hospital for further surgical treatment. After completing the relevant tests and excluding contraindications to surgery, he underwent arteriovenous fistula embolization under general anesthesia. After the operation, the general condition was stable, and the redness and swelling of the left eye was relieved.
Basic information】Male, 68 years old
Disease Type】Arteriovenous fistula
Hospital】Liaoning Provincial People’s Hospital
Date of Consultation】July 2021
Treatment plan】Surgical treatment (total cerebral angiography + arteriovenous fistula embolization)
Treatment Period】11 days of hospitalization, 3 months of outpatient review
Results】Postoperative angiogram showed satisfactory closure of the arteriovenous fistula, and postoperative ocular redness and swelling were relieved.
I. Initial consultation
The patient, 68 years old, came to our clinic with a complaint of redness and swelling in the left eye for 1 year, which had been aggravated for 3 months. The patient presented to our department with a diagnosis of arteriovenous fistula after undergoing a total cerebral arteriogram 2 weeks ago, and came to our department for surgical treatment. The patient was clear, mentally well, had normal diet and sleep, had normal bowel movements, and had no significant weight loss. The patient has been hypertensive for 2 years and has been taking amlodipine besylate tablets since then, and his blood pressure is still under control.
Physical examination: clear mind, clear speech, physical cooperation, redness and swelling of the left eye, decreased visual acuity, equal size and round pupils of both eyes, sensitive light reflex, free movement of both eyes, free movement of the limbs, negative bilateral Bartholin’s sign.
II. Treatment history
After admission, we further improved the routine biochemical examination, head CT, lung CT, electrocardiogram and cardiac ultrasound, etc. No abnormalities were found, and it was clear that the patient was not contraindicated for surgery. After explaining to the family and the patient, whole brain angiography was performed again under local anesthesia, and an arteriovenous fistula with a single opening in the cavernous sinus segment of the left internal carotid artery was seen.
After the patient and family agreed, the arteriovenous fistula was embolized under general anesthesia. The fistula was superselected and the Onyx gel was injected slowly. The angiogram showed satisfactory sealing of the fistula and delayed visualization of the distal veins. After the operation, the patient’s vital signs were stable and the general status was acceptable.
III. Treatment results
The patient’s surgery was successful and the postoperative results were remarkable. The postoperative angiogram showed complete closure of the arteriovenous fistula and delayed visualization of the distal veins. There was occasional headache for 3 days after the operation, and the vital signs were stable. The redness and swelling of the left eye improved, but the visual acuity still decreased. There were no neurological complications after surgery, and the patient was discharged after 11 days of comprehensive hospitalization with good healing of the puncture site and no complications such as local hematoma and pseudoaneurysm. On review 3 months after discharge, the patient’s left eye redness and swelling basically disappeared and his vision returned to normal. The whole cerebral arteriogram showed good sealing of the arteriovenous fistula and no definite recurrence of arteriovenous fistula was seen. No symptoms such as confusion, hemiparesis, aphasia and severe loss of vision occurred during the follow-up period.
IV. Precautions
It is gratifying that the patient’s arteriovenous fistula was effectively treated, but the patient and his family should be advised to control the blood pressure after arteriovenous fistula embolization, to eat a low-salt and low-fat diet, to avoid excessive intake of fat, sugar and salt, to take care of rest, to avoid heavy physical exertion, and to pay attention to diet, living and sleep. Pay attention to monitoring blood pressure, which should preferably be controlled below 130/80 mmHg. If symptoms such as confusion, hemiparesis, aphasia, or severe loss of vision occur, seek medical attention in a timely manner.
In addition, it is recommended to review the whole cerebral arteriogram regularly. If there is no abnormality, the head CTA should be reviewed after six months in outpatient clinic, and the whole cerebral arteriogram should be reviewed after one year, if the patient’s condition allows, it is recommended to review the whole cerebral arteriogram once a year in the future, if the condition does not allow, the head CTA should be reviewed at least once a year.
V. Personal insight
Clinically, most arteriovenous fistulas require arteriography to clarify the diagnosis, identify the location of the arteriovenous fistula, and select the appropriate treatment. In this article, the patient had a left internal carotid arteriovenous fistula, which is a common type of arteriovenous fistula and can cause vision loss, eye redness, pain, and lacrimation, etc. Fortunately, the patient sought medical attention in time and her condition was basically stable after choosing interventional embolization.
Interventional treatment is an emerging minimally invasive treatment in recent years, but it is worth noting that not all patients are suitable for interventional embolization treatment and should follow the guidance of a medical professional.