Superior Ophthalmic Vein Cannulation in the Management of Carotid-Cavernous Fistula: Nursing Considerations
Abstract
Background: Carotid–cavernous fistulas (CCFs) are abnormal arteriovenous communications between the carotid arterial system and the cavernous sinus, often resulting in orbital venous congestion, proptosis, chemosis, diplopia, and potential vision loss. While transvenous embolization via the inferior petrosal sinus (IPS) is the standard treatment, anatomical or pathological barriers may render this approach infeasible, necessitating alternative access routes such as superior ophthalmic vein (SOV) cannulation.
Aim: This article aims to describe the role of SOV cannulation in the management of CCFs, with particular emphasis on nursing considerations, procedural indications, technical challenges, multidisciplinary coordination, and patient safety.
Methods: A narrative, practice-focused review was conducted, synthesizing current clinical knowledge on SOV anatomy, indications, contraindications, equipment, procedural techniques, and nursing interventions involved in SOV cannulation for CCFs. Emphasis was placed on peri-procedural nursing care and interprofessional collaboration.
Results: SOV cannulation was identified as a highly effective alternative when standard venous access fails, particularly in indirect dural CCFs with predominant ophthalmic venous drainage. Successful outcomes depend on meticulous anatomical knowledge, advanced imaging guidance, skilled catheterization, and vigilant nursing monitoring to prevent complications such as orbital hemorrhage, infection, or visual deterioration.
Conclusion: SOV cannulation remains a critical, though technically demanding, intervention in selected CCF cases. Nursing expertise and coordinated interprofessional care are vital in optimizing procedural success, minimizing complications, and promoting positive patient outcomes.
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