Purpose

To describe the management of a complex periocular arteriovenous fistula and to highlight the potential risk of ignition during surgical excision following Onyx embolization.

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Methods

A 68-year-old male with a prior history of traffic accident presented with a high-flow arteriovenous fistula involving the left upper eyelid, brow, and scalp, supplied by the superficial temporal artery. A multidisciplinary approach was taken. Preoperative embolization with Onyx (ethylene-vinyl alcohol copolymer) was performed, followed by surgical excision of the lesion.

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Results

Embolization reduced vascular flow, allowing controlled resection. During the procedure, a spark was generated when the monopolar cautery made contact with the Onyx material. Despite this, complete removal of the lesion was achieved without significant bleeding or further complications. Postoperative recovery was uneventful, with good functional and aesthetic outcomes.

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Conclusion

Onyx embolization is an effective technique for high-flow periocular arteriovenous fistulas. However, there is a potential risk of ignition when monopolar cautery is used in contact with embolized material. Awareness of this phenomenon and careful intraoperative technique are essential to minimize risk and ensure safe surgical outcomes.

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Additional Authors

First name	Last name	Base Hospital / Institution
Cecilia	Schweitzer	Hospital de Clinics José de San Martín, Buenos Aires, Argentina
Victoria	Ariasgago	Hospital de Clinics José de San Martín, Buenos Aires, Argentina
Di Nisio	Lorena	Hospital de Clinics José de San Martín, Buenos Aires, Argentina
Mercedes	Azulay	Hospital de Clinics José de San Martín, Buenos Aires, Argentina
Delfina	Estrada	Hospital de Clinics José de San Martín, Buenos Aires, Argentina
Carolina	Ventola	Hospital de Clinics José de San Martín, Buenos Aires, Argentina

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