Combined transarterial and transvenous embolization of multi-hole pial arteriovenous fistula with large varix.

Background: Pial arteriovenous fistula (AVF) is a vascular fistulous disease in which the cerebral pial artery and vein are directly connected without the intervening nidus within a sub-pial space. Multi-hole pial AVFs, wherein multiple feeders flow into one drainer, are usually formed with complex angioarchitecture and are difficult to treat.

Methods: A rare case of an adult patient with hereditary hemorrhagic telangiectasia and multi-hole pial AVF was described.