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].
Electronic supplementary material
Exposure, identification and cannulation of fragile superior ophthalmic vein
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Conflict of interest
The authors declare that they have no conflict of interest.
Electronic supplementary material
The online version of this article (10.1038/s41433-018-0113-4) contains supplementary material, which is available to authorized users.
References
- 1.Gout T, Patankar T, El-Hindy N, Galantzis G. Carotid-cavernous fistula: current concepts in aetiology, investigation and management. Eye. 2018. [DOI] [PMC free article] [PubMed]
- 2.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. doi: 10.1016/j.ophtha.2006.02.050. [DOI] [PubMed] [Google Scholar]
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Supplementary Materials
Exposure, identification and cannulation of fragile superior ophthalmic vein