Successful facial artery pseudoaneurysm coiling and pedicle preservation following free tissue transfer.
Patients undergoing free tissue reconstruction are at risk for development of an anastomotic pseudoaneurysm, which may present as delayed neck hemorrhage or a pulsatile neck mass. Diagnosis may be achieved by noninvasive imaging, angiography, and exploration. Management strategies for head and neck pseudoaneurysms have included open vessel ligation, open direct vessel repair, endovascular parent vessel embolization, and, most recently, endovascular pseudoaneurysm embolization. In patients with anastomotic pseudoaneurysms where adequate flap inosculation is doubted, endovascular pseudoaneurysm embolization with pedicle preservation may be an appropriate primary treatment approach. We discuss the successful endovascular coiling of an external carotid artery branch anastomotic pseudoaneurysm in a patient one month after free tissue reconstruction of a total laryngopharyngectomy and partial glossectomy defect.
Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Andrew T
AT
Day
Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Dane J
DJ
Genther
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD.
Ferdinand
F
Hui
Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Wojciech K
WK
Mydlarz
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD.
Gillian
G
Griffith
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Shaun C
SC
Desai
D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D002342:Carotid Artery, External / Q000000981:diagnostic imaging; D004621:Embolization, Therapeutic / Q000379:methods; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000009:adverse effects / Q000637:transplantation*; D005927:Glossectomy / Q000379:methods; D005931:Glottis / Q000473:pathology / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D010611:Pharyngectomy / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects; D014062:Tongue Neoplasms / Q000556:secondary / Q000601:surgery*