Endovascular Embolization of Post-tonsillectomy Pseudoaneurysm: A Single-Center Case Series

Ascending Palatine Artery Embolization for the Treatment of Surgically Refractory Post-tonsillectomy Hemorrhage

“…Evidence for endovascular embolization of the branches of the external carotid artery as an effective treatment for severe post-tonsillectomy hemorrhage when attempts at surgical control have failed has been growing [ 2 - 5 , 7 , 8 ]. Endovascular embolization has several advantages, including: (1) the diagnostic angiographic assessment and subsequent intervention can be performed during the same procedure, (2) treatment can be targeted to one of the feeding arteries of the tonsillar fossa, as described in our case, (3) significantly shorter length of hospitalization, and (4) lower red blood cell transfusions during and post-procedure [ 2 - 5 ].…”

“…Potential risks of endovascular embolization include catheter-or wire-induced vasospasm, vessel perforation leading to extravasation of embolic material, ischemic injury to the mucosal surface and cranial nerves, inadvertent embolization of the internal carotid artery branches, and femoral artery injuries, including dissection, pseudoaneurysm, or rupture [ 4 , 5 ]. Various embolic materials, including coils, polyvinyl alcohol particles, and n-butyl-2-cyanoacrylate (NBCA) glue have been used for embolization [ 2 - 5 , 7 , 8 ].…”

Delayed rupture of a posttraumatic retromaxillary pseudoaneurysm causing massive bleeding: a case report

“…It can access microvascular structures that are difficult to reach by surgery. Furthermore, it does not require general anesthesia and has the advantage of low blood loss [ 11 ]. However, complications such as thromboembolic events, craniofacial pain, swelling and paralysis, and nasopharyngeal ulcers may occur due to intraoperative rupture of the pseudoaneurysm wall [ 12 ].…”

Endovascular Embolization for Control of Post-Tonsillectomy Hemorrhage

“…Previous reports have described endovascular embolization of branches of the external carotid artery as an effective treatment for severe post-tonsillectomy hemorrhage when attempts at surgical control have failed [5,6]. In particular, endovascular treatment may be useful in cases of delayed post-tonsillectomy bleeding by identifying rare causes of bleeding such as vascular tears or arterial pseudoaneurysm [7][8][9]. Advantages of endovascular treatment over external carotid ligation include (1) the ability to perform a diagnostic angiogram and perform intervention during the same procedure, (2) the possibility of identifying and individually targeting feeding arteries to the tonsillar fossa, and (3) the avoidance of a neck incision [5,8].…”