Department of Radiology, Erciyes University School of Medicine, Kayseri, Turkey.
Department of Otorhinolaryngology and Head&Neck Surgery, Erciyes University School of Medicine, Kayseri, Turkey.
Eur Arch Otorhinolaryngol. 2022 Feb;279(2):875-882. doi: 10.1007/s00405-021-06813-6. Epub 2021 May 14.
To report the results of the endovascular treatment of acute-massive head and neck bleeding in a single center and underline the value of computerized tomography-angiography and endovascular treatment of this desperate patient group.
Forty-eight patients who suffered from acute-massive head and neck bleeding and in whom conservative treatment options had failed were included in the study. To localize the site of the bleeding, computerized tomography-angiography was obtained above the supra-aortic level. Depending on the type and site of bleeding, an urgent angiographic evaluation and appropriate endovascular treatment procedure were performed in the same session immediately. Complete control of all active bleeding was determined as "technical success" at the end of the procedure.
The majority of the endovascular treatment indications were tumoral mass bleedings in this study. Eight patients, all of which had head and neck tumors as the cause of the bleeding underwent repeated interventional procedures due to acute re-bleeding. All patients left the angiography unit with technical success and dramatic clinical improvement. Two patients had procedure-related severe complications, such as contrast-induced nephropathy and acute cerebrovascular accident. One patient died due to massive re-bleeding during the follow-up period.
Computerized tomography-angiography is a successful imaging method to reveal the location and cause of bleeding. Endovascular treatment of acute-massive head and neck bleeding is an effective and life-saver treatment option that can be used successfully with relatively low-risk potential.
报告在单一中心对急性大量头颈部出血进行血管内治疗的结果，并强调计算机断层血管造影和血管内治疗对这一危急患者群体的价值。
本研究纳入了 48 例因急性大量头颈部出血且保守治疗失败的患者。为了定位出血部位，在主动脉以上水平进行了计算机断层血管造影。根据出血的类型和部位，在同一时段内立即进行紧急血管造影评估和适当的血管内治疗。在手术结束时，所有活动性出血完全控制被确定为“技术成功”。
在这项研究中，大多数血管内治疗的适应证是肿瘤性肿块出血。8 例患者因出血均为头颈部肿瘤，由于急性再出血而接受了重复介入治疗。所有患者均以技术成功和显著的临床改善离开血管造影室。2 例患者发生与手术相关的严重并发症，如造影剂肾病和急性脑血管意外。1 例患者在随访期间因大量再出血而死亡。
计算机断层血管造影是一种成功的成像方法，可以显示出血的位置和原因。血管内治疗急性大量头颈部出血是一种有效且可救命的治疗选择，风险相对较低。
