Transarterial embolization of the external carotid artery in the treatment of life-threatening haemorrhage following blunt maxillofacial trauma

Crt Langel; Dimitrij Lovric; Ursa Zabret; Tomislav Mirkovic; Primoz Gradisek; Anita Mrvar-Brecko; Katarina Surlan Popovic

doi:10.2478/raon-2020-0035

Figures & Tables

A flow diagram based on simplified Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines depicting the number of cases identified, included and excluded. The reasons for the exclusions are also noted.13

(A) A 3D CT reconstruction showing multiple maxillo-facial fractures. (B) An aortocervical CTA showing two small hematomas in the region of the right pterygopalatine fossa and nasal cavity (black arrows) and a cm 3 × 4 cm hematoma in the region of the left masticatory space and deep parotid space (white arrows). Also visible is a hyperdense material used in left ear tamponade (empty arrows).

(A) A lateral left ECA angiogram showing ECA laceration with 3 × 4 cm pseudoaneurysm continuing into the proximal part of the left IMA. Contrast extravasation can be observed in the vicinity of the pseudoaneurysm. (B) A fluoroscopic view showing left ECA embolization using coils (black arrow) and PHIL 25 liquid embolization agent (white arrow) under balloon flow control (empty arrow). Also of note area small number of stray coils anchored in the vessel in the region of PHIL application (white arrow). (C) A post-embolization lateral left ECA angiogram showing complete exclusion of the ECA distally to the facial artery (black arrow).

(A) A lateral right ECA angiogram showing two pseudoaneurysms in the region of the right pterygopalatine fossa and nasal cavity (black arrows). (B) Fluoroscopy showing microcatether proximally to the hematoma in the right pterygopalatine fossa (black arrow) prior to PHIL 25 application. Also visible is the embolized contralateral ECA (empty arrow). (C) A post-embolization right ECA angiogram showing complete sphenopalatine artery occlusion (black arrow). Also visible are the patent vessels proximally to the embolization.

Data from studies, case series and case reports pertaining to TAE of the ECA or its branches in the treatment of haemorrhage caused by blunt maxillofacial trauma

First author	Year Published	Case number	Vessel injured	Vessel embolized	Embolization agents used	efficacy (complete cessation of bleeding following TAE of the ECA or its branches)	complications
		1	none identified	RL ECA			partial necrosis tongue
		2	R IMA	R IMA			none
		3	R IMA	RL IMA			none
		4	none identified	RL ECA above LA			none
		5	none identified	RL ECA above LA	C		groin
Bynoe²	2003				GF	100%	hematoma
		6	none identified	RL ECA above LA	PVA		none
		7	L IMA	L IMA			none
		8	L IMA	L IMA			groin hematoma
		9	L IMA	R ECA above LA, L IMA			none
		10	none identified	R ECA above LA			none
		11	R IMA, R STA	not specified	C GF		could assessed not be
		12	R IMA	not specified	CGF		none
		13	L IMA	not specified	GF		could assessed not be
Chen¹²	2009	14	R IMA	not specified	GF	100%	none
		15	L IMA	not specified	GF		none
		16	RL IMA	not specified	GF		could assessed not be
		17	L ECA	not specified	CGF		none
		18	L IMA	not specified	GF		none
Cogbill⁴⁸	2008	19–39	not discernible due to the merging of blunt and penetrating trauma patients' data	not discernible due to the merging of blunt and penetrating trauma patients' data	CGF	85%	none
Kim⁴⁹	2011	40	not specified	L IMA	PVA	success	none
		41	not specified	R SPA			none
		42	not specified	RL SPA, IOA, FA			none
		43	not specified	L SPA			none
				RL SPA, LPA, ADTA⁶,
		44	not specified	IAA⁷, FA, LA	C		none
Komiyama⁵⁰	1998	45	not specified	RL SPA, FA	GF	100%	none
		46	not specified	BL SPA, AAA⁸	PVA		could assessed not be
		47	not specified	R STA, FA			none
		48	not specified	RL GPA⁹, EA			none
		49	not specified	RL SPA, SPAA¹⁰			none
			12 x IMA
			6 x FA
			6 x LA
Kuan⁴⁷	2015	50–76	5 x MMA¹¹ 3 x ECA1 x APA¹²	not specified	C GF PVA NBCA	92.3%; data includes one penetrating injury	no serious systemic neurologic or complications
			5x other vessels
			Note: this statistics also includes one penetrating trauma.
Langel	2020	77	LIMA + R SPA	L ECA + R SPA	CPHIL 25	success	none
			25 x IMA
			5 x MMA
			4 x ECA
			4 x SPA
			4 x STA
Liao⁴⁰	2007	78–112	2 x APA	not specified	not specified	79.4%	none reported
			1 x FA
			1 x SALA
			1 x IALA
			1 x DPA
			5 x other
			(observed contrast pooling)
Liu³	2008	113	L STA + L IMA	not specified	GF	success	none reported
Maiorello⁵¹	2011	114	L FA	L FA	Onyx 18	success	none
Mauldin⁵²	1989	115	R ECA	R ECA	C	success	none reported
Mehringer⁵²	1982	116–194	not discernible due to the merging of blunt and penetrating trauma patients' data	not discernible due to the merging of blunt and penetrating trauma patients' data	GFPVAsilastic spheres	100%	1x cerebral infarction 2x transient occulomotor nerve palsy
Mehrotra⁶	1984	195–196	R IMA	R IMA	GFPVA	success	none reported
			L IMA	L IMA	GF	success	none reported
Noy³⁸	2007	197	LIMA, RL FA	LIMA, RL FA	MSNBCA	success	none
Remonda⁵⁴	2000	198	RL IMA	not specified	CPVANBCA	success	Transient trismus
Thiex³³	2011	199	L FA	not specified	Onyx	success	none
		200	L STA	not specified	C		none
		201	L FA	not specified	C		none
Wang⁵⁵	2015	202	R STA	not specified	C	100%	none
		203	R STA	not specified	C		none
		204	L STA	not specified	C		none
Wong⁵⁶	2013	205	R IMA	R IMA	NBCA	success	none

Transarterial embolization of the external carotid artery in the treatment of life-threatening haemorrhage following blunt maxillofacial trauma

Figures & Tables

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Data from studies, case series and case reports pertaining to TAE of the ECA or its branches in the treatment of haemorrhage caused by blunt maxillofacial trauma

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