title: Endovascular Treatment to Stop Life-threatening Bleeding from Branches of the External Carotid Artery in Patients with Traumatic Maxillofacial Fracture.
abstract: OBJECTIVE
  The purpose of this study was to report our preliminary experience with endovascular treatment (EVT) for life-threatening bleeding from branches of the external carotid artery (ECA) in patients with traumatic maxillofacial fractures.
  
  
  METHODS
  A total of 12 patients seen between March 2010 and December 2014 were included in this study. All subjects met the following criteria: 1) presence of maxillofacial fracture; 2) continuous blood loss from oronasal bleeding; and 3) EVT to stop bleeding. Various clinical factors were recorded for each patient and the correlations between those factors and clinical outcome (Glasgow Outcome Scale, GOS) were evaluated.
  
  
  RESULTS
  Four patients were injured in traffic accidents, five in falls, and three by assaults. Mean initial Glasgow Coma Scale (GCS) was 6.9 ± 2.1 and the lowest hemoglobin measured was mean 6.3 ± 0.9 g/dL. GOS at discharge was 4 in five patients, 3 in three patients, and 1 (death) in four patients. GOS on follow-up (mean 13.7 months) was 5 in two patients, 4 in three patients, and 3 in three patients. Initial GCS (p= 0.016), lowest systolic blood pressure (p= 0.011), and lowest body temperature (p= 0.012) showed a significant positive correlation with good clinical outcomes. The number of units of red blood cells transfused (p= 0.030), the number of units of fresh frozen plasma transfused (p= 0.013), and the time from arrival to groin puncture (p< 0.001) showed significant negative correlation with good clinical outcomes.
  
  
  CONCLUSIONS
  It might be suggested that rapid transition to EVT could be preferable to struggling with other rescue strategies to stop life-threatening bleeding from branches of the ECA in patients with traumatic maxillofacial fractures.
authors: Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors: Woosung
authors: W
authors: Lee
authors: Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea.
authors: Yu Shik
authors: YS
authors: Shim
authors: Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea.; Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA.
authors: Joonho
authors: 0000-0003-2745-446X
authors: J
authors: Chung
keywords: Endovascular procedures; Facial bones; Hemorrhage; Maxillary artery; Maxillary fractures