Embolization treatment of pseudoaneurysms originating from the external carotid artery Deming Wang, MD,a Lixin Su, PhD,b Yifeng Han, MD,a and Xindong Fan, MD,a Shanghai, P.R. China Objective: The purpose of this study was to review a single-institution contemporary experience with embolization treatment of pseudoaneurysms (PAs) from the external carotid artery (ECA). Methods: From December 2000 to June 2014, PAs in the head and neck of 17 patients underwent embolization treatment and were retrospectively evaluated. All were treated with obliteration of the feeding artery or the PA by detachable coils or fibered coils, or both. Clinical follow-up was a mean of 91.9 months (range, 4-173 months) and was performed for all patients. Therapeutic outcomes were determined by evaluating the postprocedural image and clinical outcome of symptoms and signs. Results: The 17 consecutive patients with head and neck PAs who underwent coils embolization treatment consisted of 14 male patients (82.3%) and three female patients (17.7%). The average age was 37.5 years (range, 16-57 years). The most common symptom and sign was a pulsatile mass, seen in 15 of 17 patients, and other symptoms included pain (three patients) or bleeding (four patients). Digital substraction angiography revealed that the PAs originated from the ECA in 3 patients and others originated from the branches of the ECA, including the superficial temporal artery in 6 patients, internal maxillary artery in 4, superior thyroid artery in 2, and the facial artery and posterior auricular artery in 1. Seventeen coils embolizations for occlusion of the parent artery were performed in 14 patients with a transarterial approach and in three by direct percutaneous puncture. All patients remained symptom free, and no procedure-related complications occurred. Conclusions: Embolization treatment of PAs from the ECA is a useful alternative to standard surgical repair. This modality avoids the necessity for surgical exposure of the face and of the neck with its inherent morbidity. (J Vasc Surg 2015;61:920-6.)

Pseudoaneurysm (PA) of the external carotid artery (ECA) is very rare in clinical practice, typically developing from the rupture of its branches or trunk after injury to the blood vessel.1 The usual mechanism is trauma or iatrogenic. PA is a rare vascular complication that results from an incomplete tear of an arterial vessel wall, with resultant blood flow through the laceration into the surrounding tissues. This persistent leakage forms a gradually expanding mass that forms the PA over time.2 A PA from the branches of the ECA is relatively rarer, however, because the branches of the ECA are protected from injury in most locations by an adequate buffer of soft tissue. In addition, trauma to ECA branches usually results in total transection rather than partial laceration of the blood vessel. The most affected branches are the superficial From the Departments of Radiologya and Oral and Maxillofacial Surgery & Head and Neck Oncology,b the Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine. This research was supported by grant from the National Natural Science Foundation of China (No. 81271681). Author conflict of interest: none. Reprint requests: Xindong Fan, MD, Department of Radiology, the Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd, Shanghai 200011, P.R. China (e-mail: [email protected]). The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest. 0741-5214 Copyright Ó 2015 by the Society for Vascular Surgery. Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jvs.2014.10.093

920

temporal artery (STA), internal maxillary artery (IMA), and distal facial artery (FA). They are normally affected where they pass over a bony structure.3,4 The clinical manifestations of PA are variable, including a pulsatile mass, craniocervical pain, bleeding, dysphagia, hoarseness, and neurologic deficits.5 Therapeutic options include conservative surveillance, compression, thrombin injection, catheter-based embolization, and surgical resection.6 Different endovascular techniques for treatment of PA of the ECA have been previously described in isolated cases only. This study retrospectively evaluated a contemporary experience of patients who were treated with embolization of PA from the ECA at a single-institution. METHODS Approval from the Ninth People’s Hospital Institutional Review Board was obtained for this retrospective review of patients’ medical and imaging records. Informed patient consent for the study was also available. Patients. From December 2000 to June 2014, 17 consecutive patients with head and neck PA underwent endovascular treatment using coils. Preoperative and postoperative angiographic images were available for review in 14 patients. Thirteen patients had a history of trauma, including 8 stab wounds, 3 traffic accidents, and 2 blunt injuries, 3 patients underwent surgery, including 2 parotid tumor resections and 1 intranasal surgery, and 1 patient denied any mass-related medical history. Four patients presented with active bleeding, with one patient each with life-threatening bleeding in the neck due to rupture of a PA

JOURNAL OF VASCULAR SURGERY Volume 61, Number 4

from the ECA trunk, left-side epistaxis, bleeding from the parotid gland duct, and bleeding from a previous incision. A maxillofacial contrast-enhanced computed tomography (CT) scan was routine in every patient, and a mass that showed enhancing isodense enhancement to blood vessels confirmed a PA originating from the ECA or its branches, including the STA, IMA, superior thyroid artery, posterior auricular artery, and FA (Fig 1). The diagnosis of PA could be established after the initial evaluation. Selective and superselective digital subtraction angiography was performed in 14 patients before embolization in the same procedure who were indicated for endovascular treatment of PA. Laboratory investigations, electrocardiogram, and chest radiographs did not reveal any abnormalities. No clinical sign of facial or trigeminal lesions were found. No specific medical or familial history was present. Data for the 17 patients in our study are summarized in the Table I. Angiographic and endovascular techniques. Our routine protocol for managing PA originating from the ECA and its branches is occlusion of the parent arteries through transarterial or direct percutaneous puncture coils embolization. Two experienced interventional radiologists performed all procedures. Six patients received general anesthesia and 11 patients received local anesthesia. The Seldinger technique was used to selectively catheterize the right common femoral artery with a 5F groin sheath, and a 5F catheter was advanced into the ECA with the help of a guidewire for 14 patients presenting with deep lesions. Angiography of the ipsilateral ECA was performed, and the PA was confirmed. A microcatheter (Cordis Endovascular, Miami Lakes, Fla) was navigated into the parent arteries coaxially as close to the PA as possible, and selective angiography of the injured artery was performed to determine the detailed condition of the PA. After confirmation of the right position for superselective placement of the catheter tip to the distal of parent artery of PA, fiber coils (Cook, Bloomington, Ind) were placed to prevent retrograde flow. The microcatheter was then pulled back to the proximal site of the PA, and others coils were deployed. The diameter and length of deployed coils were based on the distal and proximal diameter of the affected artery. The parent artery arteriography demonstrated no remaining PA. After the microcatheter and guidewire were removed, a diagnostic catheter was repositioned and postembolization angiography showed total exclusion of the PA from the circulation, with good collateral filling of the patient’s artery through an external carotid anastomoses. Control angiography was performed 10 minutes after the proximal coils were deployed in the affected artery of the PA to demonstrate whether the PA had been occluded. Immediate angiographic occlusion after endovascular treatment was documented in 14 cases treated with parent vessels sacrifice. For three superficial lesions from STA, direct percutaneous puncture was performed. An 18-gauge needle

Wang et al 921

Fig 1. Axial imaging shows a pseudoaneurysm (PA) from the left internal maxillary artery (IMA).

(Cook) was used to percutaneously puncture the sac of the lesion, and then contrast injection was performed to verify the placement of the needle into the PA, followed by obliteration of proximal and distal parts of the PA with fibered coils after selective insertion of the microcatheter. Occlusion of PA was determined by confirmation of the disappearance of the pulsating mass. Ethanol embolization was used for patients with arteriovenous fistula (AVF) to obliterate remnant shunts between the injured artery and the draining vein after confirmation of the communication between the injured artery and vein by postembolization angiography after coils embolization of the proximal parent artery of the PA. No immediate complication was related to the coils embolization of the PA. Evaluation of clinical data and follow-up results. Follow-up evaluations were obtained from physical examination or telephone questionnaires, or both, for all patients after the procedure. Cure was defined as complete resolution of the clinical symptoms and signs, with complete obliteration of PA at postprocedure angiography. Otherwise, no palliation was defined as no improvement or no change of the clinical symptoms and signs. Postprocedural follow-up catheter angiography was not performed when the treatment consisted of parent vessel occlusion or ECA embolization. Follow-up contrast-enhanced CT was performed in 12 patients. RESULTS Patients and angiography. The 17 patients consisted of 14 male patients (82.3%) and three female patients

JOURNAL OF VASCULAR SURGERY April 2015

922 Wang et al

Table I. Demographics, clinical presentation of patients with pseudoaneurysm (PA) from external carotid artery (ECA) Patient

Age, years

Sex

PA location

Mechanism of injury

Clinical manifestations

Symptom duration

1 2 3 4

25 54 45 49

M M M F

Left parotid area Left parapharyngeal area Right parotid area Right parotid area

Stab wound Idiopathetic Parotid surgery Parotid surgery

2 weeks 10 months 3 weeks 2 weeks

22 46 21 13

   

16 35 15 11

Left palate Right cheek and neck Left cheek Left neck Right neck Left temporal Right neck Left nasal cavity Right neck Left cheek Right temporal Right temporal Left temporal

Stab wound Stab wound Stab wound Stab wound Stab wound Blunt trauma Stab wound Intranasal surgery Stab wound Blunt trauma Traffic accident Traffic accident Traffic accident

Pulsatile mass Pulsatile mass Pulsatile mass, Pulsatile mass, bleeding Pulsatile mass, Pulsatile mass Pulsatile mass Pulsatile mass Pulsatile mass, Pulsatile mass Pulsatile mass Epistaxis Bleeding Pulsatile mass Pulsatile mass Pulsatile mass Pulsatile mass

5 6 7 8 9 10 11 12 13 14 15 16 17

57 25 38 34 16 28 28 43 30 36 54 33 42

M M F M M M M M M M M M F

2 months 3 months 2 weeks 3 weeks 1 month 48 months 5 months 8 days 2 weeks 24 months 3 weeks 2 weeks 1 month

9 52 21 43 23 12 18 11 35 11 23 12 24

            

8 40 18 35 17 10 16 9 32 10 17 10 15

bleeding pain, pain

pain

PA size, mm

F, Female; M, male.

Table II. Result of embolization treatment of patients with a pseudoaneurysm (PA) from the external carotid artery (ECA) Patient

Affected artery

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

L STA L MA R PAA R STA L MA R ECA L MA L ECA R STHA L STA R STHA L MA R ECA L FA R STA R STA L STA

Coexisting Technique AVF used No No No No No Yes No Yes No No No No Yes No Yes No Yes

TA TA TA TA TA TA TA TA TA TA TA TA TA TA DPP DPP DPP

Anesthesia Local General General General Local Local Local Local Local Local Local General General Local Local Local Local

Embolic materials Fibered coils Detachable coils Fibered coils Fibered coils Fibered coils Detachable coils Fibered coils Detachable coils Fibered coils Fibered coils Fibered coils Fibered coils Detachable coils Fibered coils Fibered coils Fibered coils Fibered coils

þ fibered coils

þ fibered coils þ fibered coils

þ fibered coils

Clinical outcome Cure Cure Cure Cure Cure Cure Cure Cure Cure Cure Cure Cure Cure Cure Cure Cure Cure

CT follow-up, months

Clinical follow-up, months

No 8 5 1 101 98 77 78 158 No 117 65 164 48 No No No

9 11 10 4 107 102 82 83 162 130 122 69 168 54 173 121 155

AVF, Arteriovenous fistula; CT, computed tomography; DPP, direct percutaneous puncture; FA, facial artery; L, left; MA, maxillary artery; PAA, posterior auricular artery; R, right; STA, superficial temporal artery; STHA, superior thyroid artery; TA, transarterial approach.

(17.7%). The average age was 37.5 years (range, 1657 years). The most common symptom and sign was a pulsatile mass (15 patients [88.2%]). Other symptoms included pain (three patients [17.7%]) and bleeding (four patients [23.5%]). ECA angiography showed three PAs originating from the trunk and superselective angiography demonstrated that the STA (n ¼ 6), the IMA (n ¼ 4), the superior thyroid artery (n ¼ 2), the posterior auricular artery (n ¼ 1), and the FA (n ¼ 1) on the ipsilateral side of the lesions were the parent artery of the PA. At the same time, a coexisting AVF was also revealed in five patients. Outcome of coils embolization of PA. Embolization treatment of PA with coils achieved an effective therapeutic

outcome in this series (as reported in Table II). From three to six coils were used during the 17 coils embolization procedures that were performed in 17 patients, including 14 transarterial and three direct percutaneous puncture procedures. Five patients with concomitant AVF were treated by absolute ethanol embolization to occlude the remnant shunts. No patients exhibited focal swelling or functional impairment in the area of the PA after the procedures. Clinical outcomes after coils embolization included control of the pulsatile nature of the mass (15 of 15 patients), pain (3 of 3 patients), and bleeding (4 of 4 patients). All patients were followed up in clinic visits, which included palpation and imaging in the first year after the

JOURNAL OF VASCULAR SURGERY Volume 61, Number 4

Wang et al 923

Fig 2. A, A sagittal computed tomography (CT) shows a traumatic external carotid artery (ECA) pseudoaneurysm (PA) in a 25-year-old man (patient 6). A mass with obvious enhancement is demonstrated inside the right mandibular ramus and extending to the infratemporal fossa. Right common carotid artery angiography in (B) anteroposterior and (C) lateral views shows the PA and an arteriovenous fistula (AVF) between the ECA and the jugular vein. Almost invisible demonstration of the branches of ECA distal to PA is present. D, A contrast-enhanced CT scan demonstrates complete obliteration of the PA and placement of coils 2 weeks after embolization. Right common carotid artery angiography in (E) anteroposterior and (F) lateral views demonstrates no remaining PA or AVF.

procedure, and by telephone questionnaire at 6-month to 12-month intervals thereafter. The last follow-up by telephone was in June 2014. In 12 patients, occlusion of the PA was confirmed on the follow up contrast-enhanced CT (mean, 76.7 months; range, 1-164 months). The other five patients refused any further postprocedural imaging; however, they remained asymptomatic during clinical follow-up. All the patients were cured, and there was no evidence of recurrence at imaging or clinical follow-up (follow-up mean, 91.9 months; range, 4-173 months). All patients were very satisfied with the cosmetic result. Complications. No puncture site complications, transient ischemic attacks, or strokes resulted from the endovascular treatments. No patients sustained complications related to treatment of their PA. No cranial nerve palsy, skin or mucosal necrosis, coils migration, or skin erosion occurred after endovascular treatment of the PA during the clinical follow-up. DISCUSSION Coils embolization of PA from the ECA is a safe, effective, and useful alternative to standard surgical ligation of

affected artery, as shown in our series (Figs 2 and 3). No patient experienced procedurally related functional impairment or cosmetic disfiguration. The causes PA from the ECA are varied but are most commonly associated with blunt or penetrating trauma. Other causes include iatrogenic origins,7-12 inflammation, infection, vasculitis, tumor, and arteriosclerosis; however, there are also cases of unknown origins.13 STA, IMA, and FA are the most common parent arteries of PA from the ECA because these are the vessels most susceptible to injury. With the evolution of orthognathic surgery, PA from IMA is one of the most common causes of PA from iatrogenic origins.12 In our series, trauma and iatrogenic cases are the first two causes of PA. The diagnosis of PA is strongly based on previous history of trauma and on physical examination. The most important finding is the presence of a pulsating mass that is in synchrony with the heartbeat. A diagnostic needle aspiration should be avoided because of the risk of bleeding and the associated difficulty of controlling such bleeding in an office setting. In deeper lesions, such as those involving the deeper maxillofacial space from ECA or IMA branches,

924 Wang et al

JOURNAL OF VASCULAR SURGERY April 2015

Fig 3. A, An axial contrast-enhanced computed tomography (CT) scan of a of 54-year-old man with enlarging left parapharyngeal pulsatile mass (patient 2) demonstrates a mass with obvious enhancement (arrow). Angiography of the left internal maxillary artery (IMA) in (B) anteroposterior and (C) lateral views shows the pseudoaneurysm (PA). D, An axial view contrast-enhanced CT image, obtained 4 months later, shows complete obliteration of the PA (arrow). Angiography of the (E) left common carotid artery and (F) IMA reveals occlusion and no remaining of PA after embolization of the distal and proximal edge of IMA.

palpation may not detect the pulsating feeling, although the patient may feel the pulsations.2 Doppler ultrasound imaging is the most common noninvasive test and a helpful tool for the evaluation of PA by revealing a spindle shape or sac-like eccentric dilatation of the affected artery.2,14 The main advantage of this procedure is its ability to demonstrate turbulent flow and vessel dilatation with 95% accuracy for PA.14 However, Doppler ultrasound does not have the same effectiveness in deeper lesions.2 Contrast-enhanced CT, which is able to reveal a round lesion with vascular enhancement, has been advocated in severe trauma cases when a clinical examination is difficult. It can delineate the location and extent of the lesion and also reveal any coexisting pathologies that may not be easily identified clinically. However, CT has low detective sensitivity in some patients because of artifact from dental implants or metallic fragments. Therefore, magnetic resonance imaging (MRI) or conventional angiography may still be required. The characteristics of ECA PA on the MRI depend on the presence of an AVF. In patients without an AVF, the

PA presented with isointense signal intensity on the T1 weighted image (WI), hyperintense signal intensity on the T2WI, and strong enhancement on the postcontrast T1WI. Angiography is not a routinely used option for diagnosis of PA and is best used after noninvasive imaging techniques, such as duplex ultrasound imaging or MRI, have already been used, when the lesion has been evaluated, and endovascular treatment is a viable option. Despite the limitations of a CT scan, we continue to use it as the initial screening study, supplementing with MRI or conventional angiography depending on the clinical situation. Familiarity with all three modalities is important because in many situations they complement each other, and no single imaging technique should be thought of as a stand-alone option.1,15 In the present patients, contrast-enhanced CT of the suspicious lesions was preformed to confirm the diagnosis. The dilated false lumen of the ECA trunk with AVF revealed hypointense signal intensity on both T1WI and T2WI, with obvious flow voids in three patients. The clinical diagnosis of PA is confirmed by carotid angiogram before treatment.

JOURNAL OF VASCULAR SURGERY Volume 61, Number 4

Treatment for PA includes conservative management as well as various surgical and endovascular options. Conservative management includes observation and compression.14,16 Compression can be achieved with manual pressure or by ultrasound-guided compression; both techniques attempt to convert the vascular lesion into a hematoma.2 Previous reports demonstrate that many iatrogenic PA will close spontaneously, and some studies have shown that as many as 89% of untreated PA resolve spontaneously.14,17,18 However, several complications may arise while waiting for spontaneous resolution. The size of the PA can increase gradually or abruptly, followed by the compression of nerves sufficiently to cause functional impairment,19-22 which can eventually rupture and present as oral bleeding9 or epistaxis.23-25 The PA may also compress an adjacent vein, which can reduce venous outflow from the region causing distal embolization and thrombosis.2 Treatment of PA with invasive techniques is warranted, which include percutaneous ultrasound-guided thrombin injection, surgical excision, and endovascular options. We did not use duplex-guided thrombin injection because dispersion of the thrombin is poorly controlled and may lead to some complications,26 although it may also be a reasonable and acceptable option. Surgical resection of PA was also not performed due to accessing difficultly of deep-lying lesions and increased risk of damage to nerves as well as the cosmetic defect from a facial scar. Therefore, surgical exploration and excision of the PA is usually a last resort when embolization is ineffective. Endovascular approaches are appealing because some of these lesions can be remotely approached although they are within the deep maxillofacial region and at the base of the skull, thus avoiding the morbidity of extensive surgical exposure. Parent vessel sacrifice was a successful treatment technique in our series. The treatment should focus on occlusion of its distal and proximal part, especially for a larger PA of the ECA. During the past several decades, catheter-based and endovascular techniques have been used with increasing frequency for the management of PA.1,3,5,15 Catheter-based embolization is a safe, quick, and effective technique for treatment of PA. Numerous agents can be used for embolization therapy, including metallic coils, polyvinyl alcohol particles, n-butyl cyanoacrylate, and absorbable gelatin sponge.15 The strength of endovascular approaches lies in their ability to provide rapid access to surgically inaccessible vessels. Other advantages of an endovascular approach include superior cosmetics by preventing a facial scar and wound-related complications. In our center, the preferred treatment for PA from the ECA and its branches is occlusion of the affected artery by transarterial coils embolization across the neck of the PA because the affected artery is relatively small and the collateral circulation allows for vessel sacrifice. When IMA sacrifice is required, the IMA should be occluded distally at the level of the middle meningeal artery origin. The important risk when embolizing within the territory of the IMA includes occlusion of the central retinal artery and embolic

Wang et al 925

stroke because of potential anastomotic routes between the IMA and ophthalmic artery.27 In cases of more superficial PA from the STA, the lesion is occluded by direct percutaneous puncture, and the risk of complications is decreased because of no catheter-based procedure. Coils embolization relies both on the mechanical action of the coils mass itself and a thrombogenic action of clot forming within the coils pack. The coils designed for peripheral use in the series have Dacron (DuPont, Wilmington, Del) or nylon fibers that enhance the thrombogenic response. It is dangerous to pack coils into a largesize PA with an AVF, which may result in serious bleeding, caused by laceration of PA, and pneumonic embolization. Although covered stent, coils, and glues have been used for the treatment of AVF, we used absolute ethanol to obliterate the remnant shunts because of our experience in ethanol embolotherapy of arteriovenous malformations. In some instances, detachable coils were also used for PA occlusion to prevent migration of coils and nontarget embolization because these coils can be retrieved and redeployed, even after they have been completely deployed outside of the catheter. However, PA embolization with transarterial coils also has some drawbacks, although this is an appealing treatment option. First, catheterization of the aortic arch and carotid artery may cause embolic complications. Second, coils migration and extrusion is a rare long-term complication of endovascular PA treatment that has been reported in the head and neck,28-30 particularly if the embolized structure lies close to the skin or mucosal surface. Finally, coils, as a foreign body, may cause foreign body reaction and handicap follow-up with CT and MRI due to ghost imaging. CONCLUSIONS PA from the ECA and its branches is uncommon in the head and neck. The results of this study demonstrate that selected PA can be treated by transarterial or direct percutaneous puncture coils embolization in a safe and effective manner with an accepted risk. These are less invasive alternatives to the conventional open surgical approach of PA resection. AUTHOR CONTRIBUTIONS Conception and design: XF, LS, DW, YH Analysis and interpretation: DW, LS, XF Data collection: DW, LS, YH Writing the article: DW, LS, YH Critical revision of the article: DW, LS, XF Final approval of the article: DW, LS, YH, XF Statistical analysis: DW Obtained funding: XF Overall responsibility: XF DW and LS contributed equally and share first authorship. REFERENCES 1. Cox MW, Whittaker DR, Martinez C, Fox CJ, Feuerstein IM, Gillespie DL. Traumatic pseudoaneurysms of the head and neck: early endovascular intervention. J Vasc Surg 2007;46:1227-33.

926 Wang et al

2. Silva AC, O’Ryan F, Beckley ML, Young HY, Poor D. Pseudoaneurysm of a branch of the maxillary artery following mandibular sagittal split ramus osteotomy: case report and review of the literature. J Oral Maxillofac Surg 2007;65:1807-16. 3. Conner WC 3rd, Rohrich RJ, Pollock RA. Traumatic aneurysms of the face and temple: a patient report and literature review, 1644 to 1998. Ann Plast Surg 1998;41:321-6. 4. Dediol E, Manojlovic S, Biocic J, Franceski D, Ivanac G. Facial artery pseudoaneurysm without evidence of trauma. Int J Oral Maxillofac Surg 2011;40:988-90. 5. Herrera DA, Vargas SA, Dublin AB. Endovascular treatment of penetrating traumatic injuries of the extracranial carotid artery. J Vasc Interv Radiol 2011;22:28-33. 6. van Uden DJ, Truijers M, Schipper EE, Zeebregts CJ, Reijnen MM. Superficial temporal artery aneurysm: diagnosis and treatment options. Head Neck 2013;35:608-14. 7. Choi HJ, Kim JH, Lee YM, Lee JH. Pseudoaneurysm of the facial artery after the injection of local anesthetics. J Craniofac Surg 2012;23: 419-21. 8. Pappa H, Richardson D, Niven S. False aneurysm of the facial artery as complication of sagittal split osteotomy. J Craniomaxillofac Surg 2008;36:180-2. 9. Murono S, Nakanishi Y, Inoue D, Ozaki K, Kondo S, Wakisaka N, et al. Pseudoaneurysm of the lingual artery after concurrent intraarterial chemotherapy with radiotherapy for advanced tongue cancer. Head Neck 2011;33:1230-2. 10. Brandt A, Schaefer IM, Rustenbeck HH, Matthias C, Laskawi R. Aneurysm of the superficial temporal artery following parotid gland surgeryecase report and review of the literature. Oral Maxillofac Surg 2013;17:307-9. 11. Pukenas BA, Albuquerque FC, Pukenas MJ, Hurst R, Stiefel MF. Novel endovascular treatment of enlarging facial artery pseudoaneurysm resulting from molar extraction: a case report. J Oral Maxillofac Surg 2012;70:e185-9. 12. Avelar RL, Goelzer JG, Becker OE, de Oliveira RB, Raupp EF, de Magalhaes PS. Embolization of pseudoaneurysm of the internal maxillary artery after orthognathic surgery. J Craniofac Surg 2010;21: 1764-8. 13. Kim HO, Ji YB, Lee SH, Jung C, Tae K. Cases of common carotid artery pseudoaneurysm treated by stent graft. Case Rep Otolaryngol 2012;2012:674827. 14. Lonn L, Olmarker A, Geterud K, Risberg B. Prospective randomized study comparing ultrasound-guided thrombin injection to compression in the treatment of femoral pseudoaneurysms. J Endovasc Ther 2004;11:570-6. 15. Radvany MG, Gailloud P. Endovascular management of neurovascular arterial injuries in the face and neck. Semin Intervent Radiol 2010;27: 44-54. 16. Feld R, Patton GM, Carabasi RA, Alexander A, Merton D, Needleman L. Treatment of iatrogenic femoral artery injuries with ultrasound-guided compression. J Vasc Surg 1992;16:832-40.

JOURNAL OF VASCULAR SURGERY April 2015

17. Toursarkissian B, Allen BT, Petrinec D, Thompson RW, Rubin BG, Reilly JM, et al. Spontaneous closure of selected iatrogenic pseudoaneurysms and arteriovenous fistulae. J Vasc Surg 1997;25:803-8. 18. Kazmers A, Meeker C, Nofz K, Kline R, Groehn H, Oust G, et al. Nonoperative therapy for postcatheterization femoral artery pseudoaneurysms. Am Surg 1997;63:199-204. 19. Hacein-Bey L, Blazun JM, Jackson RF. Carotid artery pseudoaneurysm after orthognathic surgery causing lower cranial nerve palsies: endovascular repair. J Oral Maxillofac Surg 2013;71:1948-55. 20. Lalak NJ, Farmer E. Traumatic pseudoaneurysm of the superficial temporal artery associated with facial nerve palsy. J Cardiovasc Surg 1996;37:119-23. 21. Rhee CS, Jinn TH, Jung HW, Sung MW, Kim KH, Min YG. Traumatic pseudoaneurysm of the external carotid artery with parotid mass and delayed facial nerve palsy. Otolaryngol Head Neck Surg 1999;121: 158-60. 22. Taher AA. Traumatic external carotid artery aneurysm causing facial nerve paralysis. A case report. Int J Oral Maxillofac Surg 1991;20: 88-9. 23. Lanigan DT, Hey JH, West RA. Major vascular complications of orthognathic surgery: false aneurysms and arteriovenous fistulas following orthognathic surgery. J Oral Maxillofac Surg 1991;49: 571-7. 24. Kim YW, Baek MJ, Kim HD, Cho KS. Massive epistaxis due to pseudoaneurysm of the sphenopalatine artery: a rare post-operative complication of orthognathic surgery. J Laryngol Otol 2013;127: 610-3. 25. Crow WN, Scott BA, Guinto FC Jr, Chaljub G, Wright G, Rabassa AE, et al. Massive epistaxis due to pseudoaneurysm treated with detachable balloons. Arch Otolaryngol Head Neck Surg 1992;118:321-4. 26. Murphy M, Hughes D, Liaquat I, Edmondson R, Bullock P. Giant traumatic pseudoaneurysm of the superficial temporal artery: treatment challenges and case review. Br J Neurosurg 2006;20:159-61. 27. Geibprasert S, Pongpech S, Armstrong D, Krings T. Dangerous extracranial- intracranial anastomoses and supply to the cranial nerves: vessels the neurointerventionalist needs to know. AJNR Am J Neuroradiol 2009;30:1459-68. 28. Shin YS, Kim SY, Moon SK. Intranasal extrusion of the endovascular coil after occluding internal carotid artery for massive nasopharyngeal bleeding. Otolaryngol Head Neck Surg 2005;133:644. 29. Iguchi H, Takayama M, Kusuki M, Nakamura A, Kanazawa A, Hachiya K, et al. Transmucosal coil migration after endovascular management for carotid artery pseudoaneurysm: a late complication. Acta Otolaryngol 2007;127:447-8. 30. Hetts SW, Mong S, Sincic R, English JD, Wilson MW. Delayed transcutaneous extrusion of embolic coils after embolization of facial artery pseudoaneurysm. Interv Neuroradiol 2012;18:353-7.

Submitted Aug 12, 2014; accepted Oct 20, 2014.

Embolization treatment of pseudoaneurysms originating from the external carotid artery.

The purpose of this study was to review a single-institution contemporary experience with embolization treatment of pseudoaneurysms (PAs) from the ext...
1MB Sizes 0 Downloads 5 Views