Acute bleeding in the head and neck: Angiographic findings and endovascular management

Abstract

BACKGROUND AND PURPOSE: 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. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.