Introduction Carotid Cavernous Fistulas are defined as abnormal arteriovenous connections between the carotid artery or its branches and the cavernous sinus. The mainstay of treatment is Endovascular approach. Developments in understanding of the pathology has gradually shifted the pendulum towards transvenous approaches in majority.

Aim of Study To review and compare the safety and efficacy of transarterial vs transvenous approaches to Post Traumatic CCF in past 5 years.

Methods The anatomical, clinico-radiological data of 22 patients presenting with post traumatic CCF who underwent endovascular treatment was reviewed and safety and efficacy of Transarterial vs Transvenous approach was compared. The primary outcome was a complete occlusion rate. Secondary outcomes were peri-procedure complications, cranial nerve palsy, stroke, TIA, blindness, and death.

Results Overall, 15 patients underwent transarterial and 7 transvenous approaches respectively.

Transarterial embolisation resulted in complete obliteration in 73% cases (N = 11). Coil Embolisation had highest obliteration rate. There was 1 case of stroke, 1 mortality and 3 cases of Cranial Nerve neuropathy

Transvenous embolisation resulted in complete obliteration in 71% cases (N = 5). Coil Embolisation had highest obliteration rate. There was 1 case of haemorrhage and 1 of Cranial Nerve neuropathy.

On median follow at 6 months, there was 13% recurrence (N = 2) in transarterial group vs 20% (N =1) in transvenous group.

Conclusion No overall significant differences were identified between transarterial and transvenous embolization in terms of obliteration, recurrence or safety profile. Coil Embolisation was the most effective modality for complete obliteration of fistula.

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Abstract P111 Figure 1

Ballon closure of CCF.