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. 2017;2(1):103-106.
doi: 10.1080/23772484.2017.1330122. Epub 2017 May 26.

Recurrent post-tonsillectomy bleeding due to an iatrogenic facial artery pseudoaneurysm

Kevin J Choi  1 , Tracy Cheng  2 , Mary Ih Cobb  3 , Mirabelle B Sajisevi  1 , L Fernando Gonzalez  3 , Marisa A Ryan  1
Affiliations

Recurrent post-tonsillectomy bleeding due to an iatrogenic facial artery pseudoaneurysm

Kevin J Choi et al. Acta Otolaryngol Case Rep. 2017.

Abstract

This is a report of an illustrative case of recurrent post-tonsillectomy bleeding that was caused by an iatrogenic facial artery pseudoaneurysm and controlled by endovascular embolization. A 37 year-old female who underwent bilateral tonsillectomy for chronic tonsillitis had recurrent secondary hemorrhage despite multiple operative interventions to control the bleeding. Because of the recurrent nature of the bleeding, an angiography of the external carotid artery was performed demonstrating a pseudoaneurysm of the left facial artery with active extravasation. This was successfully embolized with ethylene vinyl alcohol copolymer and the bleeding did not recur. Most post-operative bleeds can be managed with bedside or intraoperative interventions. However, pseudoaneurysms should be considered in the differential diagnosis of recurrent bleeds refractory to surgical control.

Keywords: embolization; facial artery; pseudoaneurysm; tonsillectomy.

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Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
Digital subtraction angiography (DSA) of the left facial artery revealing an extravasating pseudoaneurym.
Figure 2
Figure 2
DSA of the left facial artery showing embolization of the pseudoaneurysm with ethylene vinyl alcohol copolymer (Onyx ®LES, Medtronics, Minneapolis, MN).
Figure 3
Figure 3
DSA of the left external carotid artery showing successful embolization of the facial artery pseudoaneurysm with cessation of hemorrhage.
See this image and copyright information in PMC

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