Zhao L-B, Shi H B, Park S, Lee D G, Shim J H, Lee D H, Suh D C
From the Departments of Radiology and Research Institute of Radiology (L.-B.Z., H.B.S., S.P., D.-g.L., J.H.S., D.H.L., D.C.S.), University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.
AJNR Am J Neuroradiol. 2014 Feb;35(2):360-6. doi: 10.3174/ajnr.A3761. Epub 2013 Oct 17.
Life-threatening bleeding in the head and neck requires urgent management. This study evaluated the angiographic findings related to head and neck bleeding and presents endovascular management techniques.
Sixty-one consecutive patients who presented with acute bleeding in the head and neck areas and subsequently underwent endovascular therapy between January 2002 and October 2012 were included in our study. We evaluated the angiographic findings, techniques, and results of endovascular management.
Contrast leakage (n = 10), pseudoaneurysm (n = 20), or both (n = 10) were the most common life-threatening angiographic findings (66%) and were the foci of immediate embolization or endoluminal vessel reconstruction. Seventeen patients (28%) had hypervascular staining of the tumor or mucosa, and 4 patients (6%) did not have any abnormal findings. The acute bleeding was successfully controlled by endovascular management according to the bleeding foci. Carotid arterial lesions, so-called "carotid blowout," required reconstructive or deconstructive therapy. Bleeding of the external carotid artery required specific branch embolization by a combination of various embolic materials. No procedure-related complications occurred except in 1 patient who experienced acute infarction caused by thromboemboli from the covered stent. Seventeen patients (28%) were retreated due to rebleeding after the mean 20-month follow-up.
Contrast leakage or a pseudoaneurysm or both seen on angiography are active bleeding foci and targets for therapy in patients with acute bleeding in the head and neck area. Despite different bleeding-control strategies according to vessel involvement, endovascular treatment is safe and effective for controlling hemorrhage.
头颈部危及生命的出血需要紧急处理。本研究评估了与头颈部出血相关的血管造影表现，并介绍了血管内治疗技术。
纳入2002年1月至2012年10月间连续61例头颈部急性出血并随后接受血管内治疗的患者。我们评估了血管造影表现、技术及血管内治疗结果。
造影剂外渗（n = 10）、假性动脉瘤（n = 20）或两者并存（n = 10）是最常见的危及生命的血管造影表现（66%），是立即栓塞或腔内血管重建的靶点。17例患者（28%）有肿瘤或黏膜的高血运染色，4例患者（6%）无任何异常表现。根据出血部位，血管内治疗成功控制了急性出血。颈动脉病变，即所谓的“颈动脉破裂”，需要重建或解构治疗。颈外动脉出血需要用多种栓塞材料联合进行特定分支栓塞。除1例患者因覆膜支架血栓栓塞导致急性梗死外，未发生与手术相关的并发症。17例患者（28%）在平均20个月的随访后因再出血而接受再次治疗。
血管造影上所见的造影剂外渗或假性动脉瘤或两者并存是头颈部急性出血患者的活动性出血靶点及治疗目标。尽管根据血管受累情况采用了不同的出血控制策略，但血管内治疗对于控制出血是安全有效的。
