Prognostic Factors of Survival From Intractable Oronasal Bleeding After Successful Transarterial Embolization

Kuan, Chen‐Hsiang; Lin, Chih‐Yun; Hsaio, Jong-Kai; Chen, Jin‐Shing; Han, Yin-Yi

doi:10.1016/j.joms.2015.03.028

Cited by 6 publications

(4 citation statements)

References 14 publications

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“…40 Kuan et al confirmed some of the findings by Liao et al and further discovered that patients with initial haemoglobin level lower than 10 g/dL and patients with brain midline shift observed by computed tomography (CT) had statistically higher odds ratios predicting mortality than their counterparts as estimated by univariate logistic regression. 47…”

Section: Survival Prognostic Factorsmentioning

confidence: 99%

Transarterial embolization of the external carotid artery in the treatment of life-threatening haemorrhage following blunt maxillofacial trauma

Langel

Lovrič

Zabret

et al. 2020

Radiology and Oncology

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BackgroundSevere bleeding after blunt maxillofacial trauma is a rare but life-threatening event. Non-responders to conventional treatment options with surgically inaccessible bleeding points can be treated by transarterial embolization (TAE) of the external carotid artery (ECA) or its branches. Case series on such embolizations are small; considering the relatively high incidence of maxillofacial trauma, the ECA TAE procedure has been hypothesized either underused or underreported. In addition, the literature on the ECA TAE using novel non-adhesive liquid embolization agents is remarkably scarce.Patients and methodsPubMed review was performed to identify the ECA TAE literature in the context of blunt maxillofacial trauma. If available, the location of the ECA injury, the location of embolization, the chosen embolization agent, and efficacy and safety of the TAE were noted for each case. Survival prognostic factors were also reviewed. Additionally, we present an illustrative TAE case using a precipitating hydrophobic injectable liquid (PHIL) to safely and effectively control a massive bleeding originating bilaterally in the ECA territories.Results and conclusionsBased on a review of 205 cases, the efficacy of TAE was 79.4–100%, while the rate of major complications was about 2–4%. Successful TAE haemostasis, Glasgow Coma Scale score ≥ 8 at presentation, injury severity score ≤ 32, shock index ≤ 1.1 before TAE and ≤ 0.8 after TAE were significantly correlated with higher survival rate. PHIL allowed for fast yet punctilious application, thus saving invaluable time in life-threatening situations while simultaneously diminishing the possibility of inadvertent injection into the ECA-internal carotid artery (ICA) anastomoses.

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Section: Survival Prognostic Factorsmentioning

confidence: 99%

Transarterial embolization of the external carotid artery in the treatment of life-threatening haemorrhage following blunt maxillofacial trauma

Langel

Lovrič

Zabret

et al. 2020

Radiology and Oncology

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“…Liao et al reported that higher GCS score ( ≥ 8) and less extensive systemic injury, represented by Injury severity scale(ISS) ≤ 32 were related to higher survival rate 8) . Kuan et al suggests that the survival of patients with successful TAE is associated with severity of trauma and concomitant brain injury 16) . In our study, the overall mortality rate was total 66.7% (16/24), 25% (2/8) in the non-embolization group, and 87.5% (14/16) in the embolization group.…”

Section: Discussionmentioning

confidence: 99%

The Role of Angiographic Interventions in Life-Threatening Traumatic Maxillofacial Bleeding

Choi

Whang

et al. 2023

J Neurointensive Care

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Background: Intravascular embolization is an effective treatment option for cases of trauma induced massive maxillofacial bleeding (MFB). However, a viable guideline for endovascular treatment of MFB has not been established yet. This article investigates on parameters to distinguish suitable candidates of endovascular embolization among trauma victims with MFB, and discusses factors related to the clinical outcomes. Methods: From January 2015 to December 2018, 24 massive MFB patients underwent tranas-femoral angiography, and 16 of them proceeded with endovascular embolization (embolization group) while the other 8 patients only received angiography as no extravasation was observed (non-embolization group). We compared laboratory values (hemoglobin, pH, lactate, base excess) and clinical factors (blood pressure, age, initial GCS, time interval from trauma to intervention) related to the massive blood loss between the 16 of embolization group and the 8 of non-embolization group. The treatment results of angiographic intervention and mortality related factors were also compared to investigate factors related to treatment outcome.Results: Compared with non-embolization group, the patients of embolization group has a trend of lower hemoglobin (7.9 ± 3.6 g/dL vs 11.6 ± 2.3 g/dL, p = 0.047), lower base excess (-14.73 vs -6.9, p = 0.002), and lower systolic & diastolic blood pressure (100.5mmHg vs 59.9mmHg, 66.0 mmHg vs 30.9mmHg, respectively, p < 0.05). The overall mortality rate was 66.7% (87.5% in embolization group, 25% in non-embolization group). In the embolization group, there was no significant difference in all clinical and laboratory values between survivors and non-survivors. Conclusion: This study suggests initial hemoglobin, base-excess and low blood pressure as possible indicators to distinguish potential beneficiaries of facial embolization among MFB victims. However, it failed to find the viable prognosis factors to predict the clinical outcome of the embolization. Larger-scale prospective studies are needed in the future.

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“…Skull base fracture is a common complication of AEDH that may easily lead to rapid and serious deterioration of the disease [7] . Many studies have shown that endovascular treatment is effective for posttraumatic oronasal hemorrhage following traumatic brain injury [8–10] . For patients with AEDH without surgical indication and complicated by massive oronasal bleeding, interventional embolization may be an effective treatment method.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of traumatic oronasal hemorrhage complicated with progressive acute epidural hemorrhage

Jin

Chen

et al. 2022

Medicine

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Rationale Massive oronasal hemorrhage can induce shock and is life-threatening, and early endovascular treatment is the standard of care. Few studies have reported the use of endovascular treatment for acute epidural hemorrhage (AEDH). However, endovascular treatment of oronasal hemorrhage complicated by AEDH has not yet been demonstrated. Many patients with a low to moderate volume of oronasal hemorrhage complicated by AEDH choose conservative treatment but eventually undergo craniotomy due to increased intracranial hemorrhage. Patient concerns A 32-year-old man presented to our hospital with traumatic oronasal hemorrhage complicated by AEDH after being hit by a blunt object. Diagnosis Computerized tomography suggested progressive AEDH and multiple basilar skull fractures. Emergency cerebral angiography showed rupture of the right middle meningeal artery and a branch of the left maxillary artery causing AEDH and oronasal hemorrhage. Interventions The patient underwent interventional embolization to treat the ruptured intracranial vessels. Outcomes After 23 days, cranial computerized tomography showed remarkable absorption of the right frontal epidural hematoma, with the patient having a Glasgow Coma Scale score of 15. Lessons This case provides a valuable treatment for patients with AEDH complicated with oronasal hemorrhage, early interventional embolization may be an effective treatment strategy to prevent further complications and ensure a good patient outcome.

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Prognostic Factors of Survival From Intractable Oronasal Bleeding After Successful Transarterial Embolization

Cited by 6 publications

References 14 publications

Transarterial embolization of the external carotid artery in the treatment of life-threatening haemorrhage following blunt maxillofacial trauma

Transarterial embolization of the external carotid artery in the treatment of life-threatening haemorrhage following blunt maxillofacial trauma

The Role of Angiographic Interventions in Life-Threatening Traumatic Maxillofacial Bleeding

Endovascular treatment of traumatic oronasal hemorrhage complicated with progressive acute epidural hemorrhage

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