Cerebrovascular Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
J Neurointerv Surg. 2012 Jul;4(4):e20. doi: 10.1136/neurintsurg-2011-010044. Epub 2011 Aug 9.
Particle embolization for epistaxis and intra-oral hemorrhage are performed on an as needed basis by neurointerventionalists. A case is presented of massive oral hemorrhage associated with end stage liver disease coagulopathy after tooth extraction of bilateral maxillary and mandibular molars. A man in his fifties with end stage liver disease who presented for evaluation of a syncopal episode was determined to be in hemorrhagic shock from 2 days of persistent oral bleeding after elective tooth extractions. Conservative management with multiple blood transfusion products, packing and vasoconstrictive spray was ineffective. Microcatheter angiograms of the alveolar arteries demonstrated blood and contrast pooling within the sockets of the extracted teeth. Selection of the bilateral supplying alveolar and inferior alveolar artery branches was achieved followed by polyvinyl alcohol particle embolization (250-355 μm). Polyvinyl alcohol particle embolization of dental socket hemorrhages is technically feasible and effective.
粒子栓塞术可按需由神经介入医生用于治疗鼻出血和口腔内出血。本文报道了 1 例终末期肝病凝血功能障碍患者在双侧上颌和下颌磨牙拔牙后发生大量口腔出血的病例。一名 50 多岁的终末期肝病男性因晕厥发作就诊，被诊断为拔牙后持续 2 天的口腔出血导致失血性休克。经多次输血制品、填塞和血管收缩喷雾保守治疗无效。牙槽动脉的微导管血管造影显示拔牙窝内有血液和造影剂积聚。随后选择双侧供血的牙槽动脉和下颌下动脉分支进行聚乙烯醇颗粒栓塞（250-355μm）。牙槽窝出血的聚乙烯醇颗粒栓塞技术上是可行且有效的。
