Transvenous balloon-protected embolization of a scalp arteriovenous fistula using Onyx liquid embolic

Acta Neurochir (Wien). 2011 Jun;153(6):1285-90. doi: 10.1007/s00701-011-0998-1. Epub 2011 Apr 9.


Background: Scalp arteriovenous fistulas (AVFs) are rare and potentially complex lesions that can be treated in a multimodal fashion. We present here the first successful treatment of a Stage Ib scalp AVF using a balloon-protected, retrograde transvenous embolization with the liquid embolic Onyx.

Method: We describe the case of a 60-year-old man with a scalp AVF that had a fine, diffuse, serpiginous arterial supply, precluding a transarterial approach, and multiple venous drainage paths, including the external jugular vein (EJV). The lesion was successfully embolized exclusively via a femoral transvenous retrograde approach using Onyx with balloon-protection of the EJV to simultaneously prevent pulmonary embolism and enable improved retrograde casting of the fistula-outflow zone.

Findings: The combined use of Onyx with proximal balloon-protection in a transvenous retrograde femoral approach is a novel method that can be used to definitively treat scalp AVFs with a defined catheter-accessible venous outflow.

Conclusion: This technique may be useful when transarterial embolization, direct puncture, or surgical excision are not practical or possible.

Publication types

  • Case Reports

MeSH terms

  • Angiography, Digital Subtraction
  • Arteriovenous Fistula / diagnostic imaging
  • Arteriovenous Fistula / therapy*
  • Catheterization / methods*
  • Dimethyl Sulfoxide / administration & dosage*
  • Embolization, Therapeutic / methods*
  • Humans
  • Image Processing, Computer-Assisted
  • Imaging, Three-Dimensional
  • Male
  • Middle Aged
  • Polyvinyls / administration & dosage*
  • Scalp / blood supply*
  • Tomography, X-Ray Computed


  • Onyx copolymer
  • Polyvinyls
  • Dimethyl Sulfoxide