Purpose To report the use of endovascular techniques for management of gun shot injuries to arteries in the head and neck requiring emergency intervention.
Material and Methods Between January 2009 and March 2011, 46 patients, admitted to a Level 1 Trauma Center with suspected gun shot injuries of the extracranial or intracranial circulation (Age range: 17–54, gender distribution: 35 males/11 females), were referred for four vessel angiograms. Four vessel angiograms were performed within 24 h after admission to confirm potential injuries to the external carotid, internal carotid and vertebral arteries (ECA, ICA or VA) and if necessary with the intent to treat by endovascular techniques.
Results In 13/46 patients, major vessel injuries, requiring immediate surgical or endovascular intervention were documented. In one patient, an internal carotid dissection causing thrombembolic stroke was successfully treated by stent placement. Two patients presenting with ruptured cervical VAs without angiographically visible active extravasation were treated by endovascular coil occlusions (1) and a combination of coils and NBCA (1). In six patients with life threatening blood loss, significant active extravasations were documented arising from the internal maxillary (4), occipital (1) or superficial temporal (1) arteries. In all cases, immediate transarterial occlusions were performed using NBCA (5) or Onyx (1). Complete occlusion of the rupture site was achieved in all patients. In two patients, arteriovenous fistulas between the common carotid artery and internal jugular vein, and the subclavian artery and vein respectively, were found. Both lesions were surgically corrected. All but two patients recovered partially or completely from their injuries. In 2 cases, intracranial vessel occlusions and extravasations were documented; no treatment was initiated due to elevated intracranial pressure causing restricted cerebral perfusion.
Conclusions Minor damages to the vessel wall are often manageable with conservative management and low dose anticoagulation or antiplatelet therapy and short-term angiographic follow-up. Major vessel injuries leading to severe extracranial dissection or angiographic occlusion, may require stent placement or complete endovascular vessel blockage. In cases with significant active extravasations and critical blood loss, immediate transarterial embolization becomes life saving measure. The use of adhesive liquids such as acrylic glue appears more efficient compared to coils or Onyx to achieve the most rapid vessel occlusion in these cases.
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Disclosures G Benndorf: None. S Yevich: None. A Barrow: None. H Shaltoni: None. M Mawad: Siemens HealthCare. Codman.
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