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E-089 Iatrogenic Post-operative Carotid Artery Pseudoaneurysms, Diagnosis and Endovascular Management
  1. E Nossek1,
  2. K Prajoy2,
  3. J Katz3,
  4. A Setton4
  1. 1Neurosurgery, Maimonides Medical Center, New York, NY
  2. 2ENT, North Shore University Hospital, Manhasset, NY
  3. 3Neurology, North Shore University Hospital, Manhasset, NY
  4. 4Neurosurgery and Radiology, North Shore University Hospital, Manhasset, NY

Abstract

Object Management of post-operative traumatic pseudoaneurysm of the external carotid and common carotid arteries has not been well characterized. Common presentation with early post-operative hemorrhages requires early diagnosis. We describe our experience with these lesions and review our diagnosis protocol, endovascular treatment and outcome.

Methods This is 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 DSA evaluation. We utilized an angiographic protocol to characterize the lesion, the vessel involved and the collateral circulation patency. We utilized combination of coils and nBCA glue embolization, 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. Immediate and early clinical and angiographic results were reviewed.

Results We have treated 16 patients in this cohort. Thirteen lesions were associated with maxillofacial/oral surgeries and three were associated with tumor surgeries. Fifteen lesions were located in the ECA branches and one was located in the CCA. Fifteen patients presented with acute hemorrhage. We identified 13 pseudoaneurysms and three vessels interruptions.

There were no procedural ruptures or complications. All aneurysms were completely obliterated, with early unpacking by ENT surgeon and hemodynamic stability, without any early re-hemorrhages. 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 associated with 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.

Disclosures E. Nossek: None. K. Prajoy: None. J. Katz: None. A. Setton: None.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work noncommercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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