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Ng DCY, Lim KT. Use of a Sengstaken-Blakemore tube in a lifesaving non-variceal oesophageal bleed from pseudoaneurysms of the superior and inferior thyroid arteries. BMJ Case Rep 2024; 17:e256539. [PMID: 38901849 DOI: 10.1136/bcr-2023-256539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024] Open
Affiliation(s)
| | - Kheng Tian Lim
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
- Department of Surgery, Gladstone Hospital, Gladstone, Queensland, Australia
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El Naamani K, Capone S, Chen CJ, Tartaglino L, Rosen M, Abbas R, Sioutas GS, Amllay A, Hunt A, Gooch MR, Herial NA, Jabbour P, Rosenwasser RH, Tjoumakaris SI. Sphenopalatine Artery Pseudoaneurysm Formation Following Facial Trauma: A Case Report and Literature Review. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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3
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Inhibition of angiotensin II type 1 receptor partially prevents acute elevation of pulmonary arterial pressure induced by endovascular ethanol injection. Hypertens Res 2022; 46:972-983. [PMID: 36539462 DOI: 10.1038/s41440-022-01132-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/05/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022]
Abstract
This study aimed to examine whether the administration of losartan can prevent acute elevation of pulmonary arterial pressure (AEPAP) induced by endovascular ethanol injection and to assess its related mechanisms. Male swine were selected and performed with absolute ethanol endovascular injection. Saline was used as the negative control. Losartan was administered preoperatively. Pulmonary arterial pressure (PAP), femoral arterial pressure (FAP) and heart rate (HR) were monitored during operations. Venous plasma and pulmonary artery (PA) tissue were harvested for analyses. Protein level was detected by Western blotting and ELISA, whereas qRT-PCR was used in mRNA detection. H & E staining and immunohistochemistry were conducted to evaluate histopathology. Ethanol injection elevated PAP in swine. The concentration of RAS ligands was elevated in plasma (all P < 0.0001) but not in PA. The level of oxidative stress increased in both plasma and PA. MRNA level of AT1R (P < 0.01, 95% CI: 0.251-1.006), not AT2R increased in PA. Losartan failed to inhibit AEPAP after all sessions of ethanol injection, and partially reversed the ethanol-induced PA remodeling. The P38 MAPK was activated after ethanol injection and could be inhibited by losartan (P < 0.01, 95% CI: -0.391 to -0.164). Ethanol also promoted the translocation of the P40-PHOX/P47-PHOX/P67-PHOX complex and the activation of NOX, which was independent from RAS. Endovascular ethanol injection can induce AEPAP mainly by activating RAS and P38 MAPK signaling. Losartan can partially prevent AEPAP and vascular remodeling owing to the promotion of NOX activity by ethanol. Mechanism diagram of endovascular ethanol injection-induced acute elevation of pulmonary arterial pressure (AEPAP) partially prevented by losartan. RAS: Renin-angiotensin system; AGT: angiotensinogen; Ang I: angiotensin I; ACE: angiotensin I converting enzyme; Ang II: angiotensin II. AT1R: angiotensin II type 1 receptor. NOX2: NADPH oxidase 2. PA: pulmonary artery.
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Endovascular embolisation of external carotid artery system haemorrhage in radiated nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2022; 279:5851-5858. [PMID: 35792916 DOI: 10.1007/s00405-022-07491-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/06/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE To review the effectiveness and safety of embolisation in managing haemorrhage from the external carotid artery (ECA) system in radiated nasopharyngeal carcinoma (NPC) patients. METHODS Radiated NPC patients who presented with severe oronasal bleeding and underwent digital subtraction angiography that excluded blowouts from the internal carotid artery from 2011 to 2021 were reviewed. Those who subsequently underwent embolisation of the ECA system were analysed for technical success rate, post-embolisation re-bleeding rate and complications. RESULTS Seventeen embolisations were performed in fifteen patients during the 10-year period. The technical success rate was 100%, however the early haemostatic rate (no re-bleed within 7 days of embolisation) was 70.6% (12/17) and the overall long-term haemostatic rate was 58.8% (10/17). The re-bleed rates of targeted and empiric embolisations were 33.3% (3/9) and 50.0% (4/8), respectively. The re-bleed rates with liquid agents, coils and particles were 0% (0/7), 33.3% (1/3) and 85.7% (6/7), respectively. Amongst the embolisations utilising liquid agents, 71.4% (5/7) were targeted, distal embolisations. All re-bleeds underwent surgical ligation or repeat embolisation; half of them further experienced recurrent bleeding. There were no significant complications with embolisation. CONCLUSION Although embolisation of the ECA system in NPC has a high technical success rate and is safe, re-bleeding appears to be common. Targeted, distal embolisation with liquid embolics appear to have good haemostatic effect. Clinicians should be aware that patients may need repeated procedures to secure haemostasis.
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Pseudoaneurysms and Orthognathic Surgery: A Systematic Review and a Proposed Algorithm of Treatment. J Craniofac Surg 2022; 34:1031-1035. [PMID: 36377043 DOI: 10.1097/scs.0000000000009134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to gather existing evidence regarding the incidence, clinical presentation, and management of pseudoaneurysms (PA) after orthognathic surgery, identify the common blood vessels involved in PA, and propose a treatment algorithm based on current evidence. The protocol for this study was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols and was registered at the International Prospective Register of Systematic Reviews under the registration number CRD42020205479. Although these are rare, oral and maxillofacial surgeons should consider PA as a possible diagnosis, specifically in the maxillary artery of patients with epistaxis, severe facial edema, and swelling following LeFort I osteotomy.
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Singh HA, Kumar I, Singh PK, Varshney A, Verma A. Endovascular Management of Iatrogenic Pseudoaneurysm of Internal Maxillary Artery after Dental Extraction. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2022. [DOI: 10.1055/s-0041-1740576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractPseudoaneurysm developing from the internal maxillary artery is a rare but potentially fatal condition. We describe a case of iatrogenic pseudoaneurysm of the internal maxillary artery developed during dental extraction and successful endovascular closure of the feeder artery. At 2-month follow-up, the patient remained well with persistent thrombosis of pseudoaneurysm.
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Affiliation(s)
- Harsh Anand Singh
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ishan Kumar
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Pramod Kumar Singh
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Anshul Varshney
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ashish Verma
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Shields J, Robichaux J, Morrow K, Crutcher C, Tender G. Rupture of a superficial temporal artery pseudoaneurysm following craniotomy. J Surg Case Rep 2021; 2021:rjab379. [PMID: 34557290 PMCID: PMC8453294 DOI: 10.1093/jscr/rjab379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/30/2021] [Accepted: 08/08/2021] [Indexed: 11/16/2022] Open
Abstract
Pseudoaneurysm of the superficial temporal artery (STA) is a rare entity that has been reported in the literature after trauma or iatrogenic injuries. We describe a unique case of STA pseudoaneurysm rupture and the clinical sequelae associated with its rupture. We report a case of pseudoaneurysm rupture of the STA that occurred 14 days after craniotomy for cerebrospinal fluid leak repair. We also review the literature, diagnosis and treatment of external carotid artery aneurysms. Rupture of a STA pseudoaneurysm is a previously unreported and serious complication that must be quickly recognized in order to control hemorrhage that may have life threatening complications.
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Affiliation(s)
- Jessica Shields
- Louisiana State University Health Sciences Center, Department of Neurosurgery, New Orleans, LA 70112, USA
| | - Jared Robichaux
- Louisiana State University Health Sciences Center, Department of Neurosurgery, New Orleans, LA 70112, USA
| | - Kevin Morrow
- Louisiana State University Health Sciences Center, Department of Neurosurgery, New Orleans, LA 70112, USA
| | - Clifford Crutcher
- Louisiana State University Health Sciences Center, Department of Neurosurgery, New Orleans, LA 70112, USA
| | - Gabriel Tender
- Louisiana State University Health Sciences Center, Department of Neurosurgery, New Orleans, LA 70112, USA
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Yajima H, Tokue H, Mori M, Aramaki Y, Sawada Y, Nakajima J, Murata M, Oshima K. Successful interventional management of mediastinal hematoma caused by thyroid ima artery injury. Acute Med Surg 2021; 8:e680. [PMID: 34262780 PMCID: PMC8253541 DOI: 10.1002/ams2.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 11/18/2022] Open
Abstract
Background The thyroid ima artery (ThIA) is a rare anatomical anomaly, commonly branching from the brachiocephalic artery. Thyroid ima artery injury can cause severe mediastinal hematoma because its descending branch extends into the mediastinum. Case presentation A 91‐year‐old man presented with syncope after a motor vehicle accident. A bruise on the chest was evident. Contrast‐enhanced computed tomography revealed a massive mediastinal hematoma with signs of active hemorrhage. Injury to a descending branch of the ThIA was indicated. Transcatheter arterial embolization (TAE) was successful in stopping the bleeding. Conclusions Although a ThIA injury is rare, it can cause serious mediastinal hematoma. Thyroid ima artery injury should be considered as a cause of traumatic mediastinal hematoma. Transcatheter arterial embolization for traumatic ThIA injury is considered a safe and effective treatment.
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Affiliation(s)
- Hisao Yajima
- Department of Gunma University Graduate School of Medicine Maebashi Japan.,Department of Diagnostic and Interventional Radiology Gunma University Graduate School of Medicine Maebashi Japan
| | - Hiroyuki Tokue
- Department of Diagnostic and Interventional Radiology Gunma University Graduate School of Medicine Maebashi Japan
| | - Mizuki Mori
- Department of Gunma University Graduate School of Medicine Maebashi Japan
| | - Yuto Aramaki
- Department of Gunma University Graduate School of Medicine Maebashi Japan
| | - Yusuke Sawada
- Department of Gunma University Graduate School of Medicine Maebashi Japan
| | - Jun Nakajima
- Department of Gunma University Graduate School of Medicine Maebashi Japan
| | - Masato Murata
- Department of Gunma University Graduate School of Medicine Maebashi Japan
| | - Kiyohiro Oshima
- Department of Gunma University Graduate School of Medicine Maebashi Japan
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Bernath MM, Mathew S, Kovoor J. Craniofacial Trauma and Vascular Injury. Semin Intervent Radiol 2021; 38:45-52. [PMID: 33883801 PMCID: PMC8049762 DOI: 10.1055/s-0041-1724012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cerebrovascular injury is a potentially devastating outcome following craniofacial trauma. Interventional radiologists play an important role in detecting, grading, and treating the different types of vascular injury. Computed tomography angiography plays a significant role in the detection of these injuries. Carotid-cavernous fistulas, extra-axial hematomas, pseudoaneurysms, and arterial lacerations are rare vessel injuries resulting from craniofacial trauma. If left untreated, these injuries can lead to vessel rupture and hemorrhage into surrounding areas. Acute management of these vessel injuries includes early identification with angiography and treatment with endovascular embolization. Endovascular therapy resolves vessel abnormalities and reduces the risk of vessel rupture and associated complications.
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Affiliation(s)
- Megan M. Bernath
- Medical Scientist Training Program, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sunu Mathew
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jerry Kovoor
- Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana
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10
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Post-traumatic pseudoaneurysm of the left posterior ear artery. ANGIOLOGIA 2021. [DOI: 10.20960/angiologia.00281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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11
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Rivera G, Lajud S, Gonzalez L, Garratón M, Labat E. Management of life-threatening post-traumatic otorrhagia. Clin Case Rep 2021; 9:5-7. [PMID: 33489125 PMCID: PMC7813099 DOI: 10.1002/ccr3.3340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/08/2020] [Accepted: 07/20/2020] [Indexed: 11/29/2022] Open
Abstract
Otorrhagia can be life-threatening, and acute control of the hemorrhage using easily accessible and practical techniques in the otolaryngology field such as Merocel packing and Kerlix gauze pressure dressing is essential to manage this complication.
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Affiliation(s)
- Gabriel Rivera
- Otolaryngology‐Head and Neck SurgeryUniversity of Puerto Rico School of MedicineSan JuanPuerto Rico
| | - Shayanne Lajud
- Otolaryngology‐Head and Neck SurgeryUniversity of Puerto Rico School of MedicineSan JuanPuerto Rico
| | - Leonardo Gonzalez
- Otolaryngology‐Head and Neck Surgery DepartmentMedical University of South CarolinaColumbiaSCUSA
| | - Miguel Garratón
- Otolaryngology‐Head and Neck SurgeryUniversity of Puerto Rico School of MedicineSan JuanPuerto Rico
| | - Eduardo Labat
- Department of Diagnostic Radiology – NeuroradiologyUniversity of Puerto Rico School of MedicineSan JuanPuerto Rico
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Xu H, Jing C, Zhou J, Min X, Zhao J, Yang L, Ren Y. Application of interventional embolization in the treatment of iatrogenic pseudoaneurysms. Exp Ther Med 2020; 20:248. [PMID: 33178346 PMCID: PMC7651869 DOI: 10.3892/etm.2020.9378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 09/04/2020] [Indexed: 02/05/2023] Open
Abstract
The present study aimed to investigate the clinical effectiveness and safety of endovascular embolization for the treatment of pseudoaneurysm secondary to previous abdominal and pelvic surgery or radiological percutaneous abdominal procedure. A retrospective review was performed on all patients with abdominal and pelvic pseudoaneurysm confirmed by CT angiography or digital subtraction angiography and treated with endovascular embolization. Different techniques of embolization with coils were applied and the outcomes, including clinical effectiveness and safety, were assessed. A total of 31 patients with a total of 32 pseudoaneurysms were included in the present study. Of these pseudoaneurysms, 23 were from the main trunks and branches of the gastroduodenal artery, 5 were from the splenic artery, 2 were from the common hepatic artery, 1 was from the right hepatic artery and 1 was from the right internal iliac artery. There were no serious complications observed and there was no occurrence of re-bleeding following embolization. The embolization of the pseudoaneurysms was successful in all patients. In conclusion, endovascular embolization is a safe and effective method for the treatment of secondary iatrogenic pseudoaneurysm in the abdomen and pelvis.
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Affiliation(s)
- Hao Xu
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Cong Jing
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Jie Zhou
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Xuli Min
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Jing Zhao
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Lin Yang
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Yongjun Ren
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
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Amin D, Satishchandran S, Hamilton JM, Grossberg JA, Abramowicz S. Management of Post-Traumatic Maxillofacial Pseudoaneurysms: Review of the Literature and Suggested Algorithm. J Oral Maxillofac Surg 2020; 78:2008.e1-2008.e9. [PMID: 32771443 DOI: 10.1016/j.joms.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022]
Abstract
A pseudoaneurysm (PA) is a collection of blood caused by an incomplete tear in the vessel wall. PA can be arterial or venous in origin. In the maxillofacial region, arterial PA can result from surgical interventions. Venous PAs in the maxillofacial region have never been described. A standardized protocol for management of post-traumatic PAs in the maxillofacial region would help clinicians make treatment decisions. On the basis of the available literature and our institutional experience, we present an algorithm for management of post-traumatic maxillofacial PAs. We also present patients from our institution who illustrate some of the management options in the algorithm.
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Affiliation(s)
- Dina Amin
- Assistant Professor, Oral and Maxillofacial Surgery, Emory University School of Medicine, Director of Oral and Maxillofacial Surgery Outpatient Clinic, Grady Memorial Hospital, Atlanta, GA.
| | - Sruthi Satishchandran
- Resident-in-Training, Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA
| | - James M Hamilton
- Assistant Professor, Otolaryngology, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Jonathan A Grossberg
- Assistant Professor, Neurosurgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Shelly Abramowicz
- Associate Professor, Oral and Maxillofacial Surgery and Pediatrics, Emory University, School of Medicine, Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
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Transarterial embolization of the external carotid artery in the treatment of life-threatening haemorrhage following blunt maxillofacial trauma. Radiol Oncol 2020; 54:253-262. [PMID: 32463389 PMCID: PMC7409609 DOI: 10.2478/raon-2020-0035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/22/2020] [Indexed: 12/19/2022] Open
Abstract
Background Severe bleeding after blunt maxillofacial trauma is a rare but life-threatening event. Non-responders to conventional treatment options with surgically inaccessible bleeding points can be treated by transarterial embolization (TAE) of the external carotid artery (ECA) or its branches. Case series on such embolizations are small; considering the relatively high incidence of maxillofacial trauma, the ECA TAE procedure has been hypothesized either underused or underreported. In addition, the literature on the ECA TAE using novel non-adhesive liquid embolization agents is remarkably scarce. Patients and methods PubMed review was performed to identify the ECA TAE literature in the context of blunt maxillofacial trauma. If available, the location of the ECA injury, the location of embolization, the chosen embolization agent, and efficacy and safety of the TAE were noted for each case. Survival prognostic factors were also reviewed. Additionally, we present an illustrative TAE case using a precipitating hydrophobic injectable liquid (PHIL) to safely and effectively control a massive bleeding originating bilaterally in the ECA territories. Results and conclusions Based on a review of 205 cases, the efficacy of TAE was 79.4–100%, while the rate of major complications was about 2–4%. Successful TAE haemostasis, Glasgow Coma Scale score ≥ 8 at presentation, injury severity score ≤ 32, shock index ≤ 1.1 before TAE and ≤ 0.8 after TAE were significantly correlated with higher survival rate. PHIL allowed for fast yet punctilious application, thus saving invaluable time in life-threatening situations while simultaneously diminishing the possibility of inadvertent injection into the ECA-internal carotid artery (ICA) anastomoses.
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Choi DH, Yoo CJ, Park CW, Kim MJ. Idiopathic Pseudoaneurysm of External Carotid Artery with Delayed Facial Palsy After Covered Stenting. World Neurosurg 2019; 128:102-105. [PMID: 31078799 DOI: 10.1016/j.wneu.2019.04.265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Idiopathic pseudoaneurysms of the external carotid artery (ECA) between the internal maxillary artery and the facial artery are rare. Endovascular covered stenting is an alternative method for surgically challenging cases; however, movable and flexible vessels may prevent the maintenance of the stent. CASE DESCRIPTION A 26-year-old woman presented with sudden swelling and pain of the left chin due to a pseudoaneurysm of the proximal ECA trunk. She had undergone endovascular covered stenting and suddenly developed facial palsy at postprocedural 1 week. Regrowth of the aneurysm and slippage of the stent were detected, and additional stenting was performed. Swelling and pain of the chin and neck and subsequently the facial palsy completely resolved, and the patient made a full recovery. CONCLUSIONS The ECA aneurysm between the internal maxillary artery and facial artery may be more floating and changeable than any other portions of the ECA, and regrowth of the ECA aneurysm may cause delayed complication. In addition, knowledge of the mechanism is necessary to help in the endovascular treatment.
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Affiliation(s)
- Dae Han Choi
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Chan Jong Yoo
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Cheol Wan Park
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Myeong Jin Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
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Transradial stenting of a carotid pseudoaneurysm. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:54-57. [PMID: 30815624 PMCID: PMC6378869 DOI: 10.1016/j.jvscit.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/22/2018] [Indexed: 11/22/2022]
Abstract
Carotid pseudoaneurysms are rare and, if treated endovascularly, are usually approached via the femoral artery. We report the case of transradial stenting of an anastomotic carotid pseudoaneurysm secondary to vertebral transposition through an existing carotid-subclavian bypass.
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17
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Endovascular Management of a Refractory Pseudoaneurysm of the Sternocleidomastoid Artery Caused by Attempted Internal Jugular Central Line Placement with Long-Term Follow-Up: A Case Report and Review. Case Rep Otolaryngol 2018; 2018:8324908. [PMID: 30405929 PMCID: PMC6199854 DOI: 10.1155/2018/8324908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 08/16/2018] [Accepted: 09/04/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction This case report shows successful treatment of a refractory sternocleidomastoid branch of the superior thyroid artery (SBSTA) pseudoaneurysm using endovascular glue embolization in a patient who refused surgery. Case Presentation A 63-year-old female with multiple comorbidities presented with a firm 7 cm tender mass located in the right neck. Ultrasound showed pseudoaneurysm and a 7 × 3.3 × 4 cm multilobular hematoma in the location of the previous central line. CTA showed a corresponding heterogeneous mass. Serial imaging demonstrated enlargement over 2 weeks. Angiogram showed contrast blush off of the SBSTA. Management and Outcome SBSTA was embolized using glue. Repeat angiogram showed embolization and no contrast blush. One month later, the mass was no longer pulsatile but present on physical exam. CTA showed decreased size. 8 months later, her neck was soft without mass. Discussion Pseudoaneurysms of the external carotid artery are rare and usually due to trauma. Pseudoaneurysms after central line placement are documented, but most are complications of femoral central lines. A handful of cases of superior thyroid artery pseudoaneurysms due to several etiologies are reported, but none involving the SBSTA. Therapeutic options include surveillance, compression, thrombin injection, embolization, and surgery. Endovascular management offers an alternative for patients unwilling or unable to undergo open surgery.
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Different Embolization Approaches for the Treatment of Posttraumatic Pseudoaneurysm of the Internal Maxillary Artery. J Craniofac Surg 2018; 29:e779-e781. [PMID: 30059419 DOI: 10.1097/scs.0000000000004751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Pseudoaneurysm is an abnormal dilation of an artery that could be caused either by iatrogenic or traumatic events and it is associated with high rupture risk. Pseudoaneurysm rarely involves internal maxillary artery. Computed tomography angiography and digital subtraction angiography are essential tools to perform a proper diagnosis and treatment of pseudoaneurysms. The authors described 2 different cases of internal maxillary artery pseudoaneurysm, treated by different embolization approaches. The first case was treated by a well-known arterial catheterism technique, whereas the second one was performed by an uncommon approach with a direct percutaneous puncture.
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Deib G, El Mekabaty A, Gailloud P, Pearl MS. Treatment of hemorrhagic head and neck lesions by direct puncture and n-BCA embolization. J Neurointerv Surg 2018; 10:e25. [PMID: 29627788 DOI: 10.1136/neurintsurg-2017-013335.rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/18/2017] [Accepted: 08/26/2017] [Indexed: 11/04/2022]
Abstract
Life-threatening bleeding in the head and neck region requires urgent management. These hemorrhagic lesions, for example, a ruptured pseudoaneurysm, are often treated by transarterial embolization (TAE), but prior intervention or surgery, inflammation, anatomic variants, and vessel tortuosity may render an endovascular approach challenging, time-consuming, and sometimes impossible. We report two cases of severe head and neck hemorrhages successfully embolized with n-butyl cyanoacrylate via direct puncture, and propose this approach as a fast, safe, and effective alternative to TAE.
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Affiliation(s)
- Gerard Deib
- Division of Interventional Neuroradiology, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
| | - Amgad El Mekabaty
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Philippe Gailloud
- Division of Interventional Neuroradiology, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
| | - Monica Smith Pearl
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Department of Radiology, Children's National Medical Center, District of Columbia, USA
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Moro A, Todaro M, Pedicelli A, Alexandre A, Pelo S, Doneddu P, Gasparini G, Garagiola U, D’Amato G, Saponaro G. Pseudoaneurysm of the internal maxillary artery secondary to subcondylar fracture: case report and literature review. J Surg Case Rep 2018; 2018:rjy080. [PMID: 29713448 PMCID: PMC5915943 DOI: 10.1093/jscr/rjy080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/14/2018] [Indexed: 11/30/2022] Open
Abstract
Pseudoaneurysms are an uncommon complication of mandibular condylar-subcondylar fractures; however, if present, their recognition and management is mandatory to avoid life-threatening situations. The authors report a case of internal maxillary artery pseudoaneurysm rupture that occurred after an open reduction and internal fixation of a mandibular subcondylar fracture, along with a review of the literature.
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Affiliation(s)
- Alessandro Moro
- Maxillo-Facial Unit, University Hospital ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy
| | - Mattia Todaro
- Maxillo-Facial Unit, University Hospital ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy
| | - Alessandro Pedicelli
- Institute of Radiology (Interventional Neuroradiology Unit) University Hospital ‘A. Gemelli’, Catholic University of Sacred Hart, Rome, Italy
| | - Andrea Alexandre
- Institute of Radiology (Interventional Neuroradiology Unit) University Hospital ‘A. Gemelli’, Catholic University of Sacred Hart, Rome, Italy
| | - Sandro Pelo
- Maxillo-Facial Unit, University Hospital ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy
| | - Piero Doneddu
- Maxillo-Facial Unit, University Hospital ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy
| | - Giulio Gasparini
- Maxillo-Facial Unit, University Hospital ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy
| | - Umberto Garagiola
- Department of Biomedical, Surgical and Oral Sciences, School of Dentistry, University of Milan, Milan, Italy
| | - Giuseppe D’Amato
- Maxillo-Facial Unit, University Hospital ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy
| | - Gianmarco Saponaro
- Maxillo-Facial Unit, University Hospital ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy
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Raherinantenaina F, Rakotorahalahy RAL, Andrianandraina MCG, Rakoto Ratsimba HN, Rajaonanahary TMA. [Management of traumatic and iatrogenic arterial pseudoaneurysms in a tropical environment]. JOURNAL DE MÉDECINE VASCULAIRE 2017; 42:338-348. [PMID: 29203040 DOI: 10.1016/j.jdmv.2017.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 09/17/2017] [Indexed: 11/19/2022]
Abstract
A false aneurysm or pseudoaneurysm (PA) is the formation of a pulsatile and encapsulated hematoma in communication with the lumen of a perforated artery. Its origin is different but most cases are associated with a traumatic event. Currently, the referenced treatment is endovascular surgery but it is not feasible for the majority of vascular surgeons working in a tropical environment. The aim of this study was to describe the diagnostic and therapeutic aspects of arterial PA (APA) encountered in our institution and to evaluate the place of open surgical technique in their management. This was a 30-month retrospective and descriptive study carried out in our institution (CHU-JRA, Antananarivo, Madagascar). Between 2012 and 2014, ten cases of APA were operated. There were 8 men with an average age of 30 years. The etiologies were accidental trauma (n=6) or iatrogenic vascular injury (n=4). Most patients had a painful and pulsatile swelling (n=8). The presence of a wound scar located on the swelling was observed in 5 patients. The false aneurysms were localized in the radial (n=3), femoral (n=2), brachial (n=2), carotid (n=2) and ulnar (n=1) arteries. The diagnosis was confirmed by ultrasound Doppler in all patients. The treatment was an open surgical procedure and consisted of lateral suture (n=4), resection with direct end-to-end anastomosis (n=1) or using autologous saphenous vein graft (n=2) or ligation (n=3). Postoperative courses and outcomes at last follow-up were uneventful with optimal patency rate.
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Affiliation(s)
- F Raherinantenaina
- Service de chirurgie vasculaire, CHU de Morafeno, 501, route d'Ivoloina, Tamatave, Madagascar.
| | | | - M C G Andrianandraina
- Service de chirurgie vasculaire, CHU de Morafeno, 501, route d'Ivoloina, Tamatave, Madagascar
| | | | - T M A Rajaonanahary
- Service de chirurgie vasculaire, CHU de Morafeno, 501, route d'Ivoloina, Tamatave, Madagascar
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Deib G, El Mekabaty A, Gailloud P, Pearl MS. Treatment of hemorrhagic head and neck lesions by direct puncture and nBCA embolization. BMJ Case Rep 2017; 2017:bcr-2017-013335. [PMID: 29070606 DOI: 10.1136/bcr-2017-013335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Life-threatening bleeding in the head and neck region requires urgent management. These hemorrhagic lesions, for example, a ruptured pseudoaneurysm, are often treated by transarterial embolization (TAE), but prior intervention or surgery, inflammation, anatomic variants, and vessel tortuosity may render an endovascular approach challenging, time-consuming, and sometimes impossible. We report two cases of severe head and neck hemorrhages successfully embolized with n-butyl cyanoacrylate via direct puncture, and propose this approach as a fast, safe, and effective alternative to TAE.
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Affiliation(s)
- Gerard Deib
- Division of Interventional Neuroradiology, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
| | - Amgad El Mekabaty
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Philippe Gailloud
- Division of Interventional Neuroradiology, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
| | - Monica Smith Pearl
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Department of Radiology, Children's National Medical Center, District of Columbia, USA
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Laurito A, Kasemi H, Monti A, Maselli M, Manzo P, Tavolini V, Gaggiano A. Percutaneous Embolization of Delayed External Carotid Artery Pseudoaneurysm Eight Years after Partial Parathyroidectomy. Ann Vasc Surg 2017; 43:311.e1-311.e4. [PMID: 28385501 DOI: 10.1016/j.avsg.2016.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 12/16/2016] [Accepted: 12/22/2016] [Indexed: 11/24/2022]
Abstract
External carotid artery pseudoaneurysm (ECAP) is very rare. The usual mechanism is trauma or iatrogenic. We report a case of a patient with an asymptomatic, chronic ECAP secondary to partial parathyroidectomy. Percutaneous injection of the 2-component Fibrin Sealant (Tisseel; Baxter int, Deerfield, IL) with the 2 active ingredients (Sealer Protein Solution and Thrombin Solution) was carried out with successful occlusion of the pseudoaneurysmal sac. The 6-month follow-up computed tomographic scan confirmed the ECAP thrombosis. The ECAP endovascular approach is less invasive and reduces the complications of the open surgical intervention, especially in high-risk patients or presenting with hostile neck.
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Affiliation(s)
- Antonella Laurito
- Department of Surgery, Vascular Surgery Unit, "Cardinal Massaia" Hospital, Asti, Italy
| | - Holta Kasemi
- Department of Surgery, Vascular Surgery Unit, "Cardinal Massaia" Hospital, Asti, Italy; Department "Paride Stefanini", Vascular Surgery Unit, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
| | - Andrea Monti
- Department of Surgery, Vascular Surgery Unit, "Cardinal Massaia" Hospital, Asti, Italy
| | - Mauro Maselli
- Department of Surgery, Vascular Surgery Unit, "Cardinal Massaia" Hospital, Asti, Italy
| | - Paola Manzo
- Department of Surgery, Vascular Surgery Unit, "Cardinal Massaia" Hospital, Asti, Italy
| | - Valeria Tavolini
- Department of Surgery, Vascular Surgery Unit, "Cardinal Massaia" Hospital, Asti, Italy
| | - Andrea Gaggiano
- Department of Surgery, Vascular Surgery Unit, "Cardinal Massaia" Hospital, Asti, Italy
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Traumatic Pseudoaneurysm of the Internal Maxillary Artery: A Rare Life-Threatening Hemorrhage as a Complication of Maxillofacial Fractures. Case Rep Med 2016; 2016:9168429. [PMID: 27999596 PMCID: PMC5141547 DOI: 10.1155/2016/9168429] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/09/2016] [Indexed: 11/21/2022] Open
Abstract
Pseudoaneurysm of the internal maxillary artery due to a traumatic event is a rare condition. Pseudoaneurysms are usually directly produced by arteries break with extravasation of blood. The compressed perivascular tissue forms the wall of aneurysmal sac. Then, this sac gradually expands and can be damaged. It is rare to see pseudoaneurysms of IMA. They are usually associated with fracture of the neck of the mandible. To the best of our knowledge the pseudoaneurysm of the internal maxillary artery related to maxillofacial trauma is an event extremely rare in the literature and if not quickly managed can lead to the patient's death. This case underlines how the close cooperation between surgeons and radiologists results in a quick diagnosis and management of such pathological events.
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Foletti JM, Bruneau S, Puech B, Guyot L, Chossegros C. Life-threatening hemorrhage after zygomatic bone surgery. About 2 posttraumatic cases. ACTA ACUST UNITED AC 2016; 117:183-7. [PMID: 27185204 DOI: 10.1016/j.revsto.2016.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/18/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Management of zygomatic bone fractures is still debated. Method and delay for intervention has to be chosen considering respective issues of operative or conservative treatments, especially hemorrhagic complications. The maxillofacial surgeon must be able to determine life-threatening situations and to react appropriately. CASES REPORT We report 2 cases of external carotid branches pseudoaneurysm leading to massive hemorrhage after early or delayed zygomatic fracture surgery. The first patient underwent open reduction of fracture by intraoral approach. An active bleeding occurred in the immediate postoperative time. In the second case, a zygomatic osteotomy was performed 1 year after fracture. Bleeding occurred 2 weeks after surgery. In both cases, angiography demonstrated a pseudoaneurysm developed from the external carotid branches. Embolisation led to rapid bleeding control. DISCUSSION Severe hemorrhage resulting from maxillofacial trauma may be life-threatening. Once the "damage control" principles applied, selective embolisation of external carotid branches is an efficient alternative to surgery for the control of bleeding resulting from ruptured pseudoaneurysm.
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Affiliation(s)
- J-M Foletti
- Aix Marseille université, IFSTTAR, LBA UMR_T 24, 13916 Marseille, France; Service de chirurgie maxillo-faciale et plastique de la face, hôpital Nord, CHU Nord, AP-HM, chemin des Bourrely, 13915 Marseille cedex 20, France; Aix-Marseille université, 13284 Marseille, France.
| | - S Bruneau
- Service de chirurgie maxillo-faciale et plastique de la face, hôpital Nord, CHU Nord, AP-HM, chemin des Bourrely, 13915 Marseille cedex 20, France; Aix-Marseille université, 13284 Marseille, France
| | - B Puech
- Aix-Marseille université, 13284 Marseille, France; Service d'imagerie, hôpital Nord, AP-HM, 13915 Marseille cedex 20, France
| | - L Guyot
- Service de chirurgie maxillo-faciale et plastique de la face, hôpital Nord, CHU Nord, AP-HM, chemin des Bourrely, 13915 Marseille cedex 20, France; Aix-Marseille université, 13284 Marseille, France
| | - C Chossegros
- Aix Marseille université, IFSTTAR, LBA UMR_T 24, 13916 Marseille, France; Service de chirurgie maxillo-faciale, hôpital de la Conception, hôpital Nord, AP-HM, pavillon étoile, chemin des Bourrely, 13005 Marseille, France
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