Endovascular Treatment of Intractable Bleeding from a Traumatic Pseudoaneurysm of the Internal Maxillary Artery

Abstract

Traumatic pseudoaneurysms of the internal maxillary artery (IMA) are rare and difficult to treat. A 58-year-old man with a traumatic pseudoaneurysm of the IMA presented with intractable nasal and oral hemorrhage during dual antiplatelet therapy. Transcatheter artery embolization with N-butyl cyanoacrylate (NBCA) completely occluded the pseudoaneurysm. Transcatheter artery embolization with NBCA is a feasible and effective treatment because of its shorter treatment time and lower incidence of recurrence.

Traumatic Pseudoaneurysm of the Internal Maxillary Artery: A Rare Life-Threatening Hemorrhage as a Complication of Maxillofacial Fractures

“…Pseudoaneurysm, or false aneurysm, is an uncommon consequence of arterial damage, resulting from an incomplete disruption of the arterial wall causing an expanding lesion between the artery and the surrounding tissues [11–14]. In such cases, the hematoma of the surrounding tissues counterbalances the arterial pressure, causing the hemorrhage, compressing and stabilizing the bleeding.…”

“…Common etiology of PA of the IMA includes blunt and penetrating traumas, orthognathic surgery, neck dissection, surgical removal of impacted third molars, and radiotherapy [11, 14]. Contrast-enhanced CT and catheter angiography are the gold standard in diagnosing PA of the IMA [16].…”

“…In other cases, complications like delayed hemorrhage, expansion, neuralgia, pain, and ischemia of the distal districts have been described [14, 16]. Because of the unpredictable course of the PA a treatment is requested once the correct diagnosis is made.…”

“…NBCA, Onyx, and SQUID penetrate deeper into the vessels and they may go into the venous system. Takeshita et al analyse some series on traumatic IMA PA treated with endovascular therapy [14]. They reported that the most common embolization agents used are metallic coils (40%), particles (28%), and NBCA (24%).…”

Predicting Arterial Injuries after Penetrating Brain Trauma Based on Scoring Signs from Emergency CT Studies

“…Coexisting vascular injury influences the management of these patients, as the prevention of bleeding from the ruptured artery is the primary goal of the therapy. Most often those patients with suspected arterial injuries undergo diagnostic digital subtraction angiography (DSA) followed by various intravascular neurointerventional procedures if needed [8][9][10] . Identification of patients with intracranial arterial injuries in emergency settings is a diagnostic challenge.…”