Introduction: Management of post-operative traumatic pseudoaneurysm of the external and common carotid arteries has not been well described. Common presentation with early post-operative hemorrhages requires early diagnosis and treatment. We describe our experience with these lesions and review our imaging protocol, endovascular treatment and outcome.
Methods: A retrospective review of patients treated between 2005-2014. Early post operative hemorrhages required immediate packing by ENT surgeon, hemodynamic stabilization and diagnostic workup, usually by CTA and selective cerebral angiography. We utilized an angiographic protocol to characterize the lesion, the vessel involved and the collateral circulation. We utilized combination of coils and nBCA to obliterate the lesion and the vessel segment along the external carotid distribution. Post embolization specific Super-selective injections were utilized to verify complete occlusion. Stent assisted coiling was performed for CCA pseudoaneurysm. Immediate and early clinical and angiographic results were reviewed.
Results: We treated 16 patients in this cohort. Thirteen lesions were associated with benign maxillofacial/oral surgeries and three were associated with surgical tumor resection. Fifteen lesions were located in the ECA branches and one located in the CCA. All patients except the patient harboring CCA pseudoaneurysm presented with acute hemorrhage. We identified angiographycally 13 pseudoaneurysms and three vessels interruptions.
There were no procedural ruptures or complications. All lesions were completely obliterated, with early unpacking by ENT and hemodynamic stability, without any early re-hemorrhage. No early or delayed signs of ischemia were noted.
Conclusions: Carotid artery pseudoaneurysm, post maxillofacial/oral surgery can be treated early and effectively by endovascular procedures. High suspicion and early diagnosis due to severe hemorrhages is crucial. Prompt imaging usually by CTA followed by selective cerebral angiography are highly effective. Utilization of coils and liquid embolic material can achieve immediate obliteration of the lesion and vessel segment. Selective post embolization studies of the collateral circulation are essential to confirm complete occlusion
Patient Care: Early diagnosis and management of severe post operative hemorrhages in a rapid and effective fashion. Imaging and endovascular treatment may solve postoperative hemorrhages promptly using minimally invasive technique.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) describe the imaging protocol for carotid pseudo aneurysm, 2)plan the endovascular management of post operative pseudoaneurysms along the ECA and the CCA, on emergency basis.