Endovascular Management of Iatrogenic Vascular Injury in the Craniocervical Region.
OBJECTIVE
To evaluate iatrogenic vascular injuries in the craniocervical region and their endovascular management.


METHODS
Twenty-one patients (9 women, 12 men) with a mean age of 53.6 years (range 16-87 years), who underwent endovascular embolization for iatrogenic vascular injury in the craniocervical region between December 2000 and October 2015, were included in this retrospective study. Types of iatrogenic injuries, etiologies that caused these injuries and details of endovascular managements were reported.


RESULTS
The etiologies of the vascular injuries were as follows: transsphenoidal surgery (n=9), skull-base surgery (n=2), cholesteatoma surgery (n=1), tracheostomy (n=2), central venous catheterization (n=2), oropharyngeal tumor operation (n=1), endovascular treatment of internal carotid artery (ICA) stenosis (n=1), suprasellar epidermoid tumor operation (n=1), sphenoid sinus tumor surgery (n=1), and speech prosthesis device placement (n=1). The types of vascular injuries diagnosed at the time of angiography were; 2 occlusions, 2 stenoses, 2 dissections, 1 carotid cavernous fistula, 8 artery rupture with extravasation, and 9 pseudoaneurysms. Endovascular management of these vascular injuries were; parent artery occlusion (PAO) (n=15), aneurysm occlusion (n=3), covered stent (n=1) and conservative management (n=2). All patients except two were successfully treated. No patient had bleeding within a 30-day period after angiography. Long-term follow-up was available in all patients without occurrence of re-bleeding. One patient died due to complications related to primary vascular injury.


CONCLUSIONS
Although iatrogenic vascular injuries are rare, early diagnosis and management may be lifesaving. Endovascular techniques are reliable and safe in most of the patients.
Başkent University, Department of Radiology, Izmir, Turkey.
Elcin
E
Aydin
Mustafa
M
Gok
Asim
A
Esenkaya
Celal
C
Cinar
Ismail
I
Oran
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D002574:Cervical Vertebrae / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000601:surgery; D019468:Disease Management; D004621:Embolization, Therapeutic / Q000295:instrumentation; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D012886:Skull / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D057772:Vascular System Injuries / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D055815:Young Adult