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Case Reports
. 2017 Oct 24:2017:bcr2017013335.
doi: 10.1136/bcr-2017-013335.

Treatment of hemorrhagic head and neck lesions by direct puncture and nBCA embolization

Gerard Deib  1 , Amgad El Mekabaty  2 , Philippe Gailloud  1 , Monica Smith Pearl  2   3
Affiliations
Case Reports

Treatment of hemorrhagic head and neck lesions by direct puncture and nBCA embolization

Gerard Deib et al. BMJ Case Rep. .

Abstract

Life-threatening bleeding in the head and neck region requires urgent management. These hemorrhagic lesions, for example, a ruptured pseudoaneurysm, are often treated by transarterial embolization (TAE), but prior intervention or surgery, inflammation, anatomic variants, and vessel tortuosity may render an endovascular approach challenging, time-consuming, and sometimes impossible. We report two cases of severe head and neck hemorrhages successfully embolized with n-butyl cyanoacrylate via direct puncture, and propose this approach as a fast, safe, and effective alternative to TAE.

Keywords: intervention; liquid embolic material; neck; technique.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
A middle-aged patient with external carotid rupture (case 1). Lateral view from a right vertebral angiogram (A) shows collateral supply to the right external carotid artery with active contrast extravasation (arrows). Under roadmap guidance provided by the right vertebral artery injection (B, C), a 21 G needle (arrows) was advanced percutaneously into the right external carotid artery near the site of extravasation. Non-subtracted images demonstrate the site of direct puncture as well as the previously placed, now occluded right common/internal carotid artery stent. Postembolization angiography (D) confirmed the absence of residual extravasation.
Figure 2
Figure 2
A 65-year-old patient with lingual artery pseudoaneurysm (case 2) (PA) (A) and lateral (B) views from a left common carotid artery angiogram prior to embolization demonstrate minute sublingual branches extending across the midline to join small right terminal lingual artery branches with persistent supply to the right-sided PA (black arrows). A 21 G micropuncture needle (white arrows) was placed in the PA (black arrows) and adequate positioning confirmed by angiography (C, D), which also demonstrated persistent extravasation. Final control angiography via the left common carotid artery (E, F) after embolization documents obliteration of the PA by the n-butyl cyanoacrylate cast (black arrows). The PA (white arrow) is difficult to prospectively identify on coronal (G) and sagittal (H) CTA reformatted images.
See this image and copyright information in PMC

References

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