27/12/2025
Embolisation of Rare Retro-Orbital High-Flow Vascular Malformation with Preservation of Vision 👁️🧠
A 55-year-old woman presented with sudden-onset, progressive visual deterioration in the right eye, accompanied by proptosis. Evaluation revealed a retro-orbital high-flow vascular malformation, predominantly supplied by branches of the ophthalmic artery and the internal maxillary artery. Initial angiography showed absence of choroidal blush on the right side.
A multidisciplinary strategy was planned, consisting of endovascular embolisation followed by surgical resection. The patient and her family were thoroughly counselled regarding procedural risks, including the possibility of complete vision loss.
Super-selective endovascular embolisation was performed by cannulating two major feeders from the ophthalmic artery along with feeders from the internal maxillary artery. Embolisation via the ophthalmic artery was undertaken with extreme caution to avoid reflux to angulation of ophthalmic artery, which gives rise to critical ocular branches, particularly the central retinal and posterior ciliary arteries.
A significant portion of the malformation was successfully devascularised. Final angiography demonstrated restoration of choroidal blush, which had been absent pre-procedure. Importantly, the patient retained vision, with marginal clinical improvement.
This case underscores how detailed knowledge of orbital vascular anatomy, meticulous super-selective catheterisation, and targeted embolisation can enable safe treatment of high-risk retro-orbital vascular malformations, while preserving vision.
