phenylephrine-hydrochloride and Aneurysm--False

Rottura dell’arteria carotide interna durante la chirurgia nasale endoscopica: nostra esperienza e review della letteratura.. La rottura iatrogena dell’arteria carotide interna è una complicanza catastrofica, sebbene non frequente, della chirurgia endoscopica nasale. In questo lavoro presentiamo la nostra esperienza nella gestione di questa emergenza. Un uomo di 52 anni è stato sottoposto ad intervento di chiusura di fistola rinoliquorale, e durante l’intervento si è verificata una copiosa emorragia durante l’apertura, mediante pinza sfenoidale di Hajek, della parete anteriore del seno sfenoidale. L’immediato tamponamento del seno sfenoidale ha controllato l’emorragia. Mediante l’esecuzione di un’angiografia urgente, è stato individuato un punto di rottura della carotide interna sinistra a livello del segmento paraclivale. Quindi inizialmente è stato posizionato uno stent, ma si è trombizzato; successivamente è stata utilizzata una spirale endovascolare. Il paziente è andato incontro ad ischemia cerebrale con emiparesi post-procedura, che si è risolta del tutto nel giro di 6 settimane. Il tamponamento nasale seguito da un’angiografia in urgenza e il posizionamento di uno stent endovascolare possono rappresentare il trattamento definitivo meno invasivo. Se lo stent non dovesse avere successo, l’occlusione mediante balloon endovascolare o l’embolizzazione mediante spirale dovrebbero essere i trattamenti di scelta quando la rivascolarizzazione dai distretti controlaterali è garantita. Il successo del trattamento si basa soprattutto sull’immediatezza della gestione da parte di un team multidisciplinare.. Iatrogenic internal carotid artery injury is a catastrophic but uncommon complication of endonasal sinus surgery. We present our experience in managing this emergency situation. A 52-year-old man underwent revision endoscopic repair of recurrent cerebrospinal fluid leak that was complicated with profuse haemorrhage during removal of the anterior wall of sphenoid sinus using a Hajek sphenoid punch forceps. Immediate packing of the sphenoid sinus controlled the haemorrhage. Urgent angiography revealed injury at the paraclival segment of the left internal carotid artery. An endovascular stent was initially placed but thrombosed; it was subsequently converted to coil embolisation. The patient had watershed cerebral infarct with hemiparesis post procedure but made full recovery within 6 weeks. Immediate nasal packing followed by urgent angiography and endovascular stent placement is the least invasive definitive treatment. If stenting is unsuccessful, endovascular balloon occlusion or coil embolisation is the next preferred treatment, if there is adequate cross-cerebral circulation. The success of treatment relies on its immediate management by a multidisciplinary team.

Topics: Aneurysm, False; Angiography; Blood Pressure; Carotid Artery Injuries; Carotid Artery, Internal; Cone-Beam Computed Tomography; Endoscopy; Endovascular Procedures; Extravasation of Diagnostic and Therapeutic Materials; Hemorrhage; Humans; Male; Middle Aged; Middle Cerebral Artery; Nose; Sphenoid Sinus; Stents; Thrombosis

To introduce pseudoaneurysm of the sphenopalatine artery as the possible aetiology of acute massive epistaxis in patients with a history of orthognathic surgery accompanied by Le Fort I osteotomy.. Case report and literature review.. This paper reports a case of acute life-threatening epistaxis following Le Fort I osteotomy. Computed tomography and angiography showed a pseudoaneurysm of the sphenopalatine artery, which was successfully treated by endovascular embolisation.. Although a pseudoaneurysm of the sphenopalatine artery following Le Fort I osteotomy is extremely rare, it should be considered as the possible aetiology of acute massive epistaxis in patients with a history of orthognathic surgery accompanied by Le Fort I osteotomy.

Topics: Adult; Aneurysm, False; Epistaxis; Humans; Male; Mandibular Osteotomy; Maxillary Artery; Nose; Orthognathic Surgical Procedures; Postoperative Complications; Tomography, X-Ray Computed

This case report describes a man in his 20s with a medical history of embolization of the right internal carotid artery who presented to the ears, nose, and throat emergency department with a wire in his mouth, throat discomfort, and irritating cough.

Topics: Aneurysm, False; Carotid Artery Injuries; Carotid Artery, Internal; Embolization, Therapeutic; Humans; Nose

Pseudoaneurysm is a well-known complication of trauma and iatrogenic injury to the vasculature. We report 3 cases of postsurgical pseudoaneurysm after Mohs surgery.. Three patients who underwent Mohs surgery for nonmelanoma skin cancers presented between 2 and 4 weeks after surgery with several days' history of painful, enlarging, pulsatile subcutaneous masses. The lesions were diagnosed as postsurgical pseudoaneurysm. During surgical repair of each lesion, we identified vascular outpouchings that were connected to the injured arteries by sinus tracts. In all 3 patients, we ligated the affected artery and the neck of each lesion and reapproximated the skin. All wounds healed well without further recurrence.. Most reported cases of pseudoaneurysm formation in the head and neck involve the superficial temporal artery and its branches, and they typically occur secondary to blunt force trauma. Our cases are unique in that they included 1 case of a superficial temporal lesion but also 2 cases outside this system: 1 of the lateral nasal artery and 1 of the angular artery. We propose operative repair as the treatment of choice for facial pseudoaneurysms that complicate dermatologic surgery.

Topics: Aged; Aged, 80 and over; Aneurysm, False; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Follow-Up Studies; Humans; Iatrogenic Disease; Male; Middle Aged; Mohs Surgery; Nose; Postoperative Complications; Risk Assessment; Sampling Studies; Skin Neoplasms; Treatment Outcome; Vascular Surgical Procedures

Topics: Adult; Aneurysm, False; Arteries; Embolization, Therapeutic; Epistaxis; Female; Humans; Male; Nasopharynx; Nose; Osteotomy, Le Fort; Postoperative Hemorrhage

Topics: Adult; Aneurysm, False; Embolization, Therapeutic; Female; Humans; Maxillary Artery; Nose; Radiography; Rhinoplasty