• Vascular Annual Meeting
• General Information
• Call for Abstracts
• Exhibitor Information
• Future Meeting Dates
• Past Meeting Information
• Contact Us

PVSS3. Traumatic Pseudoaneurysms Of The Head And Neck: Early Endovascular Intervention

Mitchell W. Cox, David R. Whittaker, Irwin M. Feuerstein, Charles J. Fox, Eric D. Adams, Leslie D. Cunningham, Christopher T. Martinez, David C. Gillespie.
Walter Reed Army Medical Center, Washington, D.C.

OBJECTIVES: Trauma to the head and neck with military munitions often presents with complex multi-system injury patterns. Vascular evaluation typically focuses on the carotid and vertebral arteries, however, trauma to branches of the external carotid artery may also result in devastating complications. Pseudoaneurysms are the most frequent finding on delayed evaluation, and can result in life-threatening episodes of re-bleeding.

METHODS: Patients evacuated from the Afghanistan and Iraq conflicts with penetrating injury to the face and/or neck were evaluated by the vascular surgery service to determine the potential for occult vascular injury. Patients with significant penetrating injury underwent Computed Tomography Angiogram (CTA) as the initial evaluation, and subsequent arteriography in cases where injuries were suspected or metallic fragments produced artifacts obscuring the vasculature. Data on all vascular evaluations was entered prospectively into a database and retrospectively reviewed.

RESULTS: Between February 2003 and March 2007, a total of 13 pseudoaneurysm of the head and neck were found in 11 patients: two in the internal carotid artery, one of the vertebral artery, and ten involving branches of the external carotid. Six pseudoaneurysms were symptomatic, of which two presented with episodes of massive bleeding and airway compromise. Seven pseudoaneurysms were treated with coil embolization, one with gelfoam embolization, two with stent grafts, two with open repair, and one with observation alone. None of the patients undergoing embolization had complications, however a stent graft of the ICA occluded early without stroke. All of the pseaudoaneurysms were resolved on follow-up CTA or angiogram.

CONCLUSIONS: Pseudoaneurysms are a common finding in patients with high-velocity gunshot wounds or blast injuries to the head and neck. Most involve branches of the external carotid and can be treated by embolization. CTA of the head and neck should be performed on all patients with high-velocity gunshot wounds to the face, and in cases of blast trauma with fragmentation wounds of the head and neck.