Transvenous embolization of indirect carotid-cavernous fistula via puncture of the cubital vein and distal radial artery

Carotid-cavernous fistula (CCF) is a pathologic communication between carotid arteries and cavernous sinus. The goal of endovascular treatment is to completely interrupt the carotid-cavernous communication with preserving normal blood flow in carotid arteries. Embolization can be performed via transarterial or transvenous access depending on anatomy and angioarchitecture of fistula. In this report, we present a 64-year-old woman with indirect CCF. Effective and safe embolization of indirect CCF was performed using distal radial access for diagnosis and navigation and cubital vein for simultaneous venous access for therapeutic endovascular manipulations, completely avoiding femoral access.