Endovascular Treatment of Scalp AVF Following Hair Transplantation: Case Report

Scalp arteriovenous fistulas (AVF) following hair transplantation are rare; few single case reports have been described. Therapeutic options include open surgery, percutaneous, and transarterial endovascular embolization; in recent years, these latter have gained favour because of their minimally invasive approach also concerning post-treatment cutaneous appearance. A 29-year-old male after 3 months from a hair transplantation procedure began to notice a little pulsatile mass beneath the skin of the forehead. Subsequent diagnostic imaging (CTA and angiography) showed the presence of a scalp frontoparietal AVF with a single superficial temporal artery (STA) feeder and a superficial subcutaneous venous drainage. After a few months, a sudden worsening of symptoms was reported. Endovascular treatment was performed in general anaesthesia, with right femoral arterial access, ECA catheterization, superselective STA microcatheterization right at fistula point, and embolization with platinum detachable coils. No procedural complications occurred. Patient was discharged on the 4th day, asymptomatic. Clinical symptoms resolved promptly after just 3–4 weeks. A control angiogram after 6 months showed complete disappearance of the fistula. Hair transplantation procedures are associated with a low risk profile, and scalp AVF is a very rare complication; both endovascular interventions and open surgery are safe and effective in treating this complication. A complete preliminary angiographic study is needed; if vascular anatomy is favourable, a transarterial approach can be performed. Coiling occlusion compared to glue embolization avoids cutaneous discoloration and/or subcutaneous mass among the fistulous point. In this case, this technique was proven to be safe and effective.