We appreciate the comments by Gout et al. [1] We agree that some superior ophthalmic veins are extremely fragile and difficult to cannulate, even with the available microcatheters (see supplemental video). We also agree that performing a Valsalva maneuver may make it easier to insert the microcatheter into the vessel. One still must be careful not to perforate the vessel as the catheter is advanced, as catastrophic visual complications can result, as emphasized in our manuscript and in the paper by Leibovitch et al., which we (and Gout et al.) have referenced [2].
References
Gout T, Patankar T, El-Hindy N, Galantzis G. Carotid-cavernous fistula: current concepts in aetiology, investigation and management. Eye. 2018.
Leibovitch I, Modjtahedi S, Duckwiler GR, Goldberg RA. Lessons learned from difficult or unsuccessful cannulations of the superior ophthalmic vein in the treatment of cavernous sinus dural fistulas. Ophthalmology. 2006;113:1220–6.
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Henderson, A.D., Miller, N.R. Reply to ‘Comment on: Carotid-cavernous fistula: current concepts in aetiology, investigation and management’. Eye 32, 1676 (2018). https://doi.org/10.1038/s41433-018-0113-4
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DOI: https://doi.org/10.1038/s41433-018-0113-4