Published in:
01-06-2003 | Clinical Investigations
Endovascular Therapy of Traumatic Vascular Lesions of the Head
and Neck
Authors:
Orlando Diaz-Daza, Francisco J. Arraiza, John M. Barkley, Cliff J. Whigham
Published in:
CardioVascular and Interventional Radiology
|
Issue 3/2003
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Abstract
Pseudoaneurysm and fistula formation are
well-documented complications of arterial vascular injury and may be
associated with significant morbidity and mortality. The purpose of
this manuscript is to review the presentation and therapy of patients
with traumatic vascular injuries of the head and neck. Eight patients
were admitted to a Level 1 Trauma Center and diagnostic angiography of
the carotid artery and vertebral circulation was performed. The
mechanisms of injury included motor vehicle accident, gunshot wound,
stab wound and aggravated assault. Cause of trauma, vascular lesion,
endovascular therapy and outcome were analyzed retrospectively. The
angiographic findings, clinical presentation and hospital course were
reviewed. There were eight patients, seven males and one female, aged
17–65. Four patients (50%) had multiple lesions; four had
pseudoaneurysms, two with fistula formation and two with active
arterial hemorrhage. A total of 17 lesions were embolized using coils,
Polyvinyl Alcohol (PVA), Gelfoam or a combination. Two of the 17
lesions received stents. Six of the eight patients remained clinically
improved or stable at varying follow-up intervals. One of the four
patients who presented with penetrating trauma and neurological
deficits had resolution of right hemiplegia at the 8th
month follow-up. One of the four patients who sustained blunt trauma
and carotid-cavernous fistula presented with a new pseudoaneurysm at
the 2-month post-embolization follow-up. The evolution of diagnostic
neuroangiographic techniques provides opportunities for endovascular
therapy of traumatic vascular lesions of the head and neck that are
minimally invasive, attractive options in selected cases.