Valsalva-Assisted CT Angiography Can Help Predict Vascular Malformations Outflow

Angiography lab equipment
An inside view of an angiography/catheter lab with scanning equipment in place ready for use. There are six monitors in the lab above the table the patient lies on which are showing results of a recent head scan (x-ray and CT).
Study compares traditional venography with valsalva-assisted CT angiography in identifying drainage to the cavernous sinus.

This article is part of Ophthalmology Advisor’s Focus on Retina coverage from the 2021 meeting of the American Academy of Ophthalmology, held in New Orleans from November 12 to 15, 2021. The team at Ophthalmology Advisor will be reporting on a variety of the research presented by the retinal experts at the AAO. Check back for more from the AAO 2021 Meeting.


Valsalva-assisted CT angiography (CTA) has potential to identify vascular malformations (VM) with direct outflow to the cavernous sinus (CS), according to results presented at the American Academy of Ophthalmology 2021 meeting, held in New Orleans from November 12-15.

In a consecutive case series, investigators reviewed 9 VM patients who had both a traditional venography (CV) as well as Valsalva CTA. Patients were divided into 2 groups based on the presence or absence of flow to the CS as identified by CV. 

Out of the 9 patients, 5 had lesions with direct outflow to the CS.  In comparison with CV, CTA showed VMs with direct drainage to the CS had a greater change in size of the ipsilateral superior ophthalmic vein (SOV) (P =.016) and were located more posteriorly (P =.016). However, researchers found no difference in other parameters such as, preValsalva ipsi-/contralateral SOV size, Δ3D volume, or Δcontralateral SOV between the CV and Valsalva CTA groups. 

“Features on Valsalva CTA are helpful in identifying VMs with direct drainage to the CS. These findings may allow for optimization of embolization technique,” according to the presenters.

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Roelofs KA, Diniz SB, Cohen LM, Goldberg RA, Rootman DB. Prediction of primary outflow in distensible vascular malformations of the orbit using Valsalva CT angiography. Paper presented at: The American Academy of Ophthalmology 2021 Annual Meeting; November 12-15, 2021; New Orleans. Abstract PA057.