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

Crt Langel
Crt Langel
, 
Dimitrij Lovric
Dimitrij Lovric
, 
Ursa Zabret
Ursa Zabret
, 
Tomislav Mirkovic
Tomislav Mirkovic
, 
Primoz Gradisek
Primoz Gradisek
, 
Anita Mrvar-Brecko
Anita Mrvar-Brecko
 and 
Katarina Surlan Popovic
Katarina Surlan Popovic
   | May 28, 2020
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Article Category: Review
Published Online: May 28, 2020
Page range: 253 - 262
Received: Feb 07, 2020
Accepted: Apr 22, 2020
DOI: https://doi.org/10.2478/raon-2020-0035
© 2020 Crt Langel, Dimitrij Lovric, Ursa Zabret, Tomislav Mirkovic, Primoz Gradisek, Anita Mrvar-Brecko, Katarina Surlan Popovic, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

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 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

Figure 2

(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 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).

Figure 3

(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 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).

Figure 4

(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.
(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 authorYear PublishedCase numberVessel injuredVessel embolizedEmbolization agents usedefficacy (complete cessation of bleeding following TAE of the ECA or its branches)complications
1none identifiedRL ECApartial necrosis tongue
2R IMAR IMAnone
3R IMARL IMAnone
4none identifiedRL ECA above LAnone
5none identifiedRL ECA above LACgroin
Bynoe22003GF100%hematoma
6none identifiedRL ECA above LAPVAnone
7L IMAL IMAnone
8L IMAL IMAgroin hematoma
9L IMAR ECA above LA, L IMAnone
10none identifiedR ECA above LAnone
11R IMA, R STAnot specifiedC GFcould assessed not be
12R IMAnot specifiedCGFnone
13L IMAnot specifiedGFcould assessed not be
Chen12200914R IMAnot specifiedGF100%none
15L IMAnot specifiedGFnone
16RL IMAnot specifiedGFcould assessed not be
17L ECAnot specifiedCGFnone
18L IMAnot specifiedGFnone
Cogbill48200819–39not discernible due to the merging of blunt and penetrating trauma patients' datanot discernible due to the merging of blunt and penetrating trauma patients' dataCGF85%none
Kim49201140not specifiedL IMAPVAsuccessnone
41not specifiedR SPAnone
42not specifiedRL SPA, IOA, FAnone
43not specifiedL SPAnone
RL SPA, LPA, ADTA6,
44not specifiedIAA7, FA, LACnone
Komiyama50199845not specifiedRL SPA, FAGF100%none
46not specifiedBL SPA, AAA8PVAcould assessed not be
47not specifiedR STA, FAnone
48not specifiedRL GPA9, EAnone
49not specifiedRL SPA, SPAA10none
12 x IMA
6 x FA
6 x LA
Kuan47201550–765 x MMA11 3 x ECA1 x APA12not specifiedC GF PVA NBCA92.3%; data includes one penetrating injuryno serious systemic neurologic or complications
5x other vessels
Note: this statistics also includes one penetrating trauma.
Langel202077LIMA + R SPAL ECA + R SPACPHIL 25successnone
25 x IMA
5 x MMA
4 x ECA
4 x SPA
4 x STA
Liao40200778–1122 x APAnot specifiednot specified79.4%none reported
1 x FA
1 x SALA
1 x IALA
1 x DPA
5 x other
(observed contrast pooling)
Liu32008113L STA + L IMAnot specifiedGFsuccessnone reported
Maiorello512011114L FAL FAOnyx 18successnone
Mauldin521989115R ECAR ECACsuccessnone reported
Mehringer521982116–194not discernible due to the merging of blunt and penetrating trauma patients' datanot discernible due to the merging of blunt and penetrating trauma patients' dataGFPVAsilastic spheres100%1x cerebral infarction 2x transient occulomotor nerve palsy
Mehrotra61984195–196R IMAR IMAGFPVAsuccessnone reported
L IMAL IMAGFsuccessnone reported
Noy382007197LIMA, RL FALIMA, RL FAMSNBCAsuccessnone
Remonda542000198RL IMAnot specifiedCPVANBCAsuccessTransient trismus
Thiex332011199L FAnot specifiedOnyxsuccessnone
200L STAnot specifiedCnone
201L FAnot specifiedCnone
Wang552015202R STAnot specifiedC100%none
203R STAnot specifiedCnone
204L STAnot specifiedCnone
Wong562013205R IMAR IMANBCAsuccessnone
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