title: Superselective microcatheter embolization of hemorrhage after buccal lipectomy.
abstract: BACKGROUND
  Superselective microcatheter angiography and embolization has been shown to be an effective modality for prompt treatment of bleeding from traumatic facial injury and refractory epistaxis when local methods fail to achieve hemostasis. It obviates the need for further surgical exploration and provides precise diagnostic and therapeutic modalities in a minimally invasive manner. Despite this successful profile, its use in treatment of hemorrhagic complications after facial aesthetic surgery is underreported. This report is a unique case of life-threatening hemorrhage after buccal fat pad lipectomy that was successfully treated with superselective microcatheter embolization of internal maxillary artery branches.
  
  
  METHODS
  A 31-year-old male was transferred to our emergency room from an outside facility with an active intraoral hemorrhage after a buccal lipectomy in which severe bleeding was encountered deep within the buccal space that persisted despite further attempts at surgical exploration. On arrival to the emergency room, the patient demonstrated signs of significant blood loss and had intraoral packing in place tamponading further hemorrhage.
  
  
  RESULTS
  The patient underwent resuscitation and stabilization with endotracheal intubation for airway protection and was sent emergently to the angiography suite. Superselective angiography was used to study branches of the internal maxillary artery. Superselective embolization using microspheres was then performed on target vessels to control the bleeding. The surgical packing was then removed with no evidence of active bleeding. The patient was transferred to the surgical intensive care unit for further monitoring and was discharged the following day in stable condition.
  
  
  CONCLUSIONS
  In the case of refractory surgical measures, superselective microcatheter angiography and embolization provides an alternative to both precisely localize and control severe small-artery bleeding. This may be ideal in cases that otherwise would require extensive dissection and in regions of complex anatomy, both of which can compromise aesthetic outcomes. We demonstrated the use of this method in a case of refractory bleeding after facial lipectomy. The expanding role of superselective angiography and specifically designed embolic agents may play an invaluable role in treatment of arterial injury after aesthetic surgery when local methods fail.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.
authors.affiliation: Department of Surgery, Lenox Hill Hospital, 100 East 77th Street, New York, NY 10075, USA. rengdahl@lenoxhill.net
authors.forename: Ryan
authors.initials: R
authors.lastname: Engdahl
authors.forename: Naiem
authors.initials: N
authors.lastname: Nassiri
authors.forename: Bushra
authors.initials: B
authors.lastname: Mina
authors.forename: Jennifer
authors.initials: J
authors.lastname: Drury
authors.forename: Robert
authors.initials: R
authors.lastname: Rosen
mesh_terms: D000328:Adult; D000792:Angiography / Q000295:instrumentation*; D057785:Catheters; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D004867:Equipment Design; D006801:Humans; D015187:Lipectomy / Q000009:adverse effects*; D008297:Male; D009055:Mouth / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000628:therapy*