Endovascular treatment of a pseudoaneurysm of a recipient external carotid artery following radiation and free tissue transfer

Abstract

Radical resection and reconstruction after preoperative radiation has become routine treatment for patients with certain types and stages of head and neck cancers. When microvascular flap reconstruction is required, the recipient vessels have been subjected to radiation, making them more thrombogenic and friable, thus increasing the risks of postoperative complications. The authors report a patient who received preoperative radiation therapy for rhabdomyosarcoma of the infratemporal fossa and who underwent a radical resection and free rectus musculocutaneous flap reconstruction. The free flap covered the base of the brain from the nasopharynx and closed an intraoral defect. The donor artery was anastomosed end to side to the external carotid artery stump. The patient developed a pseudoaneurysm of the external carotid artery stump 1 month postoperatively, which was treated with endovascular coil embolization without loss of the flap. Percutaneous transcatheter endovascular treatment of pseudoaneurysms that develop after free tissue transfer in head and neck reconstruction has not been reported previously. One month after surgery, endovascular occlusion of the main arterial supply to the flap did not compromise its viability because of collateral revascularization from the peripheral tissue bed, despite the patient's history of radiation.