Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Endovascular Treatment of Traumatic Pseudoaneurysm Presenting as Intractable Epistaxis

  • Zhang, Chang Wei (Department of Neurosurgery, West China Hospital, Sichuan University) ;
  • Xie, Xiao Dong (Department of Neurosurgery, West China Hospital, Sichuan University) ;
  • You, Chao (Department of Neurosurgery, West China Hospital, Sichuan University) ;
  • Mao, Bo Yong (Department of Neurosurgery, West China Hospital, Sichuan University) ;
  • Wang, Chao Hua (Department of Neurosurgery, West China Hospital, Sichuan University) ;
  • He, Min (Department of Neurosurgery, West China Hospital, Sichuan University) ;
  • Sun, Hong (Department of Neurosurgery, West China Hospital, Sichuan University)
  • Received : 2010.04.11
  • Accepted : 2010.07.07
  • Published : 2010.12.01
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Abstract

Objective: To investigate the clinical efficacy of individual endovascular management for the treatment of different traumatic pseudoaneurysms presenting as intractable epistaxis. Materials and Methods: For 14 consecutive patients with traumatic pseudoaneurysm presenting as refractory epistaxes, 15 endovascular procedures were performed. Digital subtraction angiography revealed that the pseudoaneurysms originated from the internal maxillary artery in eight patients; and all were treated with occlusion of the feeding artery. In six cases, they originated from the internal carotid artery (ICA); out of which, two were managed with detachable balloons, two with covered stents, one by means of cavity embolization, and the remaining one with parent artery occlusion. All of these cases were followed up clinically from six to 18 months, with a mean follow up time of ten months; moreover, three cases were also followed with angiography. Results: Complete cessation of bleeding was achieved in all the 15 instances (100%) immediately after the endovascular therapies. Of the six patients who suffered from ICA pseudoaneurysms, one presented with a permanent stroke and one had an episode of rebleeding requiring intervention. Conclusion: In patients presenting with a history of craniocerebral trauma, traumatic pseudoaneurysm must be considered as a differential diagnosis. Individual endovascular treatment is a relatively safe, plausible, and reliable means of managing traumatic pseudoaneurysms.

Keywords

References

  1. Tan LK, Calhoun KH. Epistaxis. Med Clin North Am 1999;83:43-56 https://doi.org/10.1016/S0025-7125(05)70086-9
  2. Viducich RA, Blanda MP, Gerson LW. Posterior epistaxis: clinical features and acute complications. Ann Emerg Med 1995;25:592-596 https://doi.org/10.1016/S0196-0644(95)70169-9
  3. Sokoloff J, Wickbom I, McDonald D, Brahme F, Goergen TC, Goldberer LE. Therapeutic percutaneous embolization in intractable epistaxis. Radiology 1974;111:285-287
  4. Quintana F, Diez C, Gutierrez A, Diez ML, Austin O, Vazquez A. Traumatic aneurysm of the basilar artery. AJNR Am J Neuroradiol 1996;17:283-285
  5. Karamoskos P, Dohrmann PJ. Traumatic internal carotid artery aneurysm and massive epistaxis. Aust N Z J Surg 1989;59:745- 747 https://doi.org/10.1111/j.1445-2197.1989.tb01668.x
  6. Auyeung KM, Lui WM, Chow LC, Chan FL. Massive epistaxis related to petrous carotid artery pseudoaneurysm after radiation therapy: emergency treatment with covered stent in two cases. AJNR Am J Neuroradiol 2003;24:1449-1452
  7. Nishioka H, Ohno S, Ikeda Y, Ohashi T, Haraoka J. Delayed massive epistaxis following endonasal transsphenoidal surgery. Acta Neurochir (Wien) 2007;149:523-526 https://doi.org/10.1007/s00701-007-1134-0
  8. Chen D, Concus AP, Halbach VV, Cheung SW. Epistaxis originating from traumatic pseudoaneurysm of the internal carotid artery: diagnosis and endovascular therapy. Laryngoscope 1998;108:326-331 https://doi.org/10.1097/00005537-199803000-00004
  9. Feiz-Erfan I, Horn EM, Theodore N, Zabramski JM, Klopfenstein JD, Lekovic GP, et al. Incidence and pattern of direct blunt neurovascular injury associated with trauma to the skull base. J Neurosurg 2007;107:364-369 https://doi.org/10.3171/JNS-07/08/0364
  10. Lasjaunias P, Marsot-Dupuch K, Doyon D. The radio-anatomical basis of arterial embolisation for epistaxis. J Neuroradiol 1979;6:45-53
  11. Cockroft KM, Carew JF, Trost D, Fraser RA. Delayed epistaxis resulting from external carotid artery injury requiring embolization: a rare complication of transsphenoidal surgery: case report. Neurosurgery 2000;47:236-239
  12. Nishioka H, Haraoka J, Ikeda Y. Risk factors of cerebrospinal fluid rhinorrhea following transsphenoidal surgery. Acta Neurochir (Wien) 2005;147:1163-1166 https://doi.org/10.1007/s00701-005-0586-3
  13. Fontela PS, Tampieri D, Atkinson JD, Daniel SJ, Teitelbaum J, Shemie SD. Posttraumatic pseudoaneurysm of the intracavernous internal carotid artery presenting with massive epistaxis. Pediatr Crit Care Med 2006;7:260-262 https://doi.org/10.1097/01.PCC.0000216418.01278.5E
  14. Renn WH, Rhoton AL Jr. Microsurgical anatomy of the sellar region. J Neurosurg 1975;43:288-298 https://doi.org/10.3171/jns.1975.43.3.0288
  15. Song HH, Won YD, Kim YJ, Kim BS. The endovascular management of saccular posterior inferior cerebellar artery aneurysms. Korean J Radiol 2008;9:396-400 https://doi.org/10.3348/kjr.2008.9.5.396
  16. Bavinzski G, Killer M, Knosp E, Ferraz-Leite H, Gruber A, Richling B. False aneurysms of the intracavernous carotid artery--report of 7 cases. Acta Neurochir (Wien) 1997;139:37- 43 https://doi.org/10.1007/BF01850866
  17. Eckert B, Thie A, Carvajal M, Groden C, Zeumer H. Predicting hemodynamic ischemia by transcranial Doppler monitoring during therapeutic balloon occlusion of the internal carotid artery. AJNR Am J Neuroradiol 1998;19:577-582
  18. Goleas J, Mikhael MA, Paige ML, Wolff AP. Intracavernous carotid artery aneurysm presenting as recurrent epistaxis. Ann Otol Rhinol Laryngol 1991;100:577-579
  19. Quintana F, Diez C, Gutierrez A, Diez ML, Austin O, Vazquez A. Traumatic aneurysm of the basilar artery. AJNR Am J Neuroradiol 1996;17:283-285
  20. Karamoskos P, Dohrmann PJ. Traumatic internal carotid artery aneurysm and massive epistaxis. Aust N Z J Surg 1989;59:745- 747 https://doi.org/10.1111/j.1445-2197.1989.tb01668.x
  21. Lempert TE, Halbach VV, Higashida RT, Dowd CF, Urwin RW,Balousek PA, et al. Endovascular treatment of pseudoaneurysms with electrolytically detachable coils. AJNR Am J Neuroradiol 1998;19:907-911
  22. Struffert T, Buhk JH, Buchfelder M, Rohde V, Doerfler A, Knauth M. Coil migration after endovascular coil occlusion of internal carotid artery pseudoaneurysms within the sphenoid sinus. Minim Invasive Neurosurg 2009;52:89-92 https://doi.org/10.1055/s-0029-1215579
  23. Celil G, Engin D, Orhan G, Barbaros C, Hakan K, Adil E. Intractable epistaxis related to cavernous carotid artery pseudoaneurysm: treatment of a case with covered stent. Auris Nasus Larynx 2004;31:275-278 https://doi.org/10.1016/j.anl.2004.03.007
  24. Choi SY, Won JY, Lee do Y, Choi D, Shim WH, Lee KH. Percutaneous transabdominal approach for the treatment of endoleaks after endovascular repair of infrarenal abdominal aortic aneurysm. Korean J Radiol 2010;11:107-114 https://doi.org/10.3348/kjr.2010.11.1.107
  25. Li MH, Li YD, Gao BL, Fang C, Luo QY, Cheng YS, et al. A new covered stent designed for intracranial vasculature: application in the management of pseudoaneurysms of the cranial internal carotid artery. AJNR Am J Neuroradiol 2007;28:1579- 1585 https://doi.org/10.3174/ajnr.A0668
  26. Ruiz-Juretschke F, Castro E, Mateo Sierra O, Iza B, Manuel Garbizu J, Fortea F. Massive epistaxis resulting from an intracavernous internal carotid artery traumatic pseudoaneurysm: complete resolution with overlapping uncovered stents. Acta Neurochir (Wien) 2009;151:1681-1684 https://doi.org/10.1007/s00701-009-0294-5

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