Walsh & Hoyt: Treatment

The optimum treatment of a direct CCF is closure of the abnormal arteriovenous communication with preservation of internal carotid artery patency. A variety of procedures can be used to close the fistula, but many (e.g., ligation of the internal carotid artery, occlusion of the fistula using the nondetachable balloon tip of a Fogarty catheter, trapping of the fistula by occlusion of the artery both proximal and distal to the fistula) also occlude the internal carotid artery. When the artery is occluded, the patient may suffer extensive neurologic deficits from hypoxic damage to the ipsilateral cerebral hemisphere. In addition, occlusion of the internal carotid artery may so reduce arterial blood flow to the eye that the patient develops hypotony, proliferative retinopathy, neovascular glaucoma, blindness, and even devastating ischemic necrosis of the eyelids and orbital contents