Multiple Spontaneous Arteriovenous Fistulas of the Superficial Temporal Artery

OBJECTIVE: Multiple spontaneous arteriovenous fistulas (AVFs) of the external carotid artery (ECA) are rare. We present a case of multiple spontaneous AVFs treated by coil embolization using a combination of the transarterial and transvenous approach. CASE PRESENTATION: A 59-year-old woman complained of right pulsatile tinnitus and a mass lesion at the ventral region of the right ear. 3D CTA and cerebral angiography revealed two AVFs on the superficial temporal artery (STA) with an aneurysm 9.8 mm in diameter. A balloon guiding catheter was navigated to the right STA via the right femoral artery. Another balloon guiding catheter was navigated to the right external jugular vein. The STA distal to the aneurysm was embolized with platinum coils by a transvenous approach. The STA proximal to the aneurysm was embolized transarterially and draining veins were embolized transvenously. Her symptoms were cured after endovascular embolization. MRA at 1 day and 6 months postoperatively showed no recurrence of AVFs or aneurysm. CONCLUSION: Coil embolization of multiple spontaneous AVFs of the ECA using a combined transarterial and transvenous approach is a curable treatment option. Transvenous embolization of an STA distal to an aneurysm is useful.