Face skin necrosis following embolization for arteriovenous malformations: a case report

Endovascular Embolization for Traumatic Facial Artery Pseudoaneurysm: A Case Report

This article presents a rare case of a facial artery pseudoaneurysm that developed following blunt trauma to the right buccal region. The patient, a 75-year-old male, sought medical attention four days after sustaining an injury from a stone impact, reporting pain and swelling in the right mandibular area. During the physical examination, a pulsatile mass was identified in the region of the facial artery. Color Doppler ultrasound confirmed the presence of a facial artery pseudoaneurysm, which was further validated by CT angiography. A team of vascular surgeons and interventional radiologists opted for endovascular embolization as the treatment approach. The procedure, performed under local anesthesia using embolic coils, was completed without complications. Follow-up imaging at two weeks and three months post-procedure confirmed successful occlusion of the pseudoaneurysm, with no signs of recurrence. This case illustrates that endovascular embolization is a safe and effective treatment for facial artery pseudoaneurysms, offering a minimally invasive alternative to traditional surgical methods that may carry risks such as scarring and excessive bleeding.

Traumatic Pseudoaneurysm Arising From Proximal Facial Artery: A Case Report and Literature Review

Pseudoaneurysms of facial artery usually arise from the distal part of the vessel. Only 4 cases were described in the literature involving the proximal part of facial artery. We present a case of a traumatic pseudoaneurysm involving the proximal part of facial artery. A 50-year-old man was referred to our department for a progressively growing submandibular mass. He was injured by a sharp object during a car crash 30 days ago. After 3 weeks, the patient noted the appearance of a subcutaneous mass in the left submandibular area. Physical examination revealed a freely movable, painful, and pulsatile swelling. Ultrasound and computerized tomography scan showed a nodular lesion in the left submandibular area in continuity with the facial artery. The diagnosis of pseudoaneurysm of facial artery was suspected. The patient was treated by surgery. The pseudoaneurysm was resected with ligation of the proximal and distal ends of the facial artery.

Systematic review of pediatric mandibular arteriovenous malformations

OBJECTIVES

The management of arteriovenous malformations (AVMs) can be challenging in the pediatric population. It is of utmost importance to keep in mind various management options as these lesions can have disastrous outcomes. This is a systematic review of the treatment AVMs describing the current practices so that practitioners can be aware of what is currently reported in the literature. The challenges of AVM management can be mitigated when approaching these patients through a multidisciplinary team-based approach.

METHODS

A systematic review of the literature was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to gain insight into pediatric mandibular AVMs. Demographics, arterial involvement, clinical symptoms, imaging, treatment, complications, follow-up, and outcomes were reviewed.

RESULTS

63 articles were included in the systematic review with 106 distinct cases. The age range was from 3 to 17 years with a mean of 12 years. 51% of the patients were female. The most common clinical presentation was emergency hemorrhage (37.4%), swelling or edema (33.0%), and persistent bleeding (31.9%). The most common CT findings were osteolytic changes and radiolucencies (60.8%). With regards to treatment, 56.6% of patients had embolization alone and 34.9% were treated with embolization in combination with other surgical treatments. Of the patients who had surgical resection of the lesion, 50% had resection followed by reconstruction, 23.7% had curettage of the lesion, and 13.2% had resection/curettage then immediate reimplantation of the mandible segment. The most common complications after intervention included bleeding in 17.9% of patients and infection in 8.3% of patients. 89.5% of patients were clinically cured without recurrence at follow-up.

CONCLUSION

Diagnosing AVMs can be difficult as they have variable clinical and radiographical presentations. Although rare, because of risk of massive hemorrhage, it is important for healthcare professionals to be aware of this pathology. Many surgical techniques, routes of embolization, embolic material, and other experimental therapies have been described and this review shows that the most cases had embolization as a part of the treatment. The role of therapies targeted at the molecular level still needs to be further explored.

Recognition and management of dermatologic complications from interventional radiology procedures

A variety of dermatologic complications can occur after interventional radiology procedures, including fluoroscopy-induced radiation dermatitis, thermal skin injury from tumor ablation, non-target embolization to the skin, allergic reactions related to interventional radiology procedures, and dermatitis and infections at catheter sites. Yet, interventional radiologists typically lack training in dermatology. This review focuses on recognition of dermatologic complications and introduces basic principles for management of these complications. By taking a more active role in the diagnosis, management, and follow-up of dermatologic complications, interventional radiologists can improve the care for patients suffering iatrogenic skin inury.

Embolization as the Primary Treatment for Mandibular Arteriovenous Malformations: An Analysis of 50 Literature Reports and of an Illustrative Case

PURPOSE

The aim of the present report is to describe 50 cases in the literature of mandibular arteriovenous malformations (AVMs) in which embolization was the primary treatment and to discuss details such as age, gender, materials used, outcome of embolization, time of follow-up, and intra- or postprocedure complications. An illustrative case in which reossification was noticed after embolization also is presented.

PATIENTS AND METHODS

The study was carried out in 2 steps. In the first, an electronic search without time restriction for embolization as the primary treatment for mandibular AVMs was performed on Medline through PubMed. In the second, the case of a patient with mandibular AVM and massive oral bleeding episodes is described after a long-term follow-up.

RESULTS

Clinical stability with the cessation of oral bleeding episodes was detected in 25 cases and 2 cases were planned for another embolization session. Clinical stability and reossification were detected in 23 of the 50 cases included. Complications were reported in 50% of cases, but most were minor and transient.

CONCLUSION

Currently, owing to more sophisticated imaging techniques, the diagnosis of mandibular AVMs is quicker and new, less invasive techniques that avoid surgical resection have proved effective. It should be emphasized that these techniques are not without complications and that long-term monitoring is extremely important.

Acute hemifacial ischemia as a late complication of carotid stenting

Concerns about carotid artery stenting (CAS) center primarily on procedural complications like acute occlusion, stroke, and long-term intrastent restenosis. External carotid artery (ECA) thrombosis is observed during CAS follow-up, but it often remains asymptomatic or, at worst, results in jaw claudication. We report here a case of late occlusion of the ECA after CAS with symptoms of acute homolateral facial ischemia as well as pain, cyanosis, tongue numbness, and skin coldness. The patient was submitted to local thrombolysis and balloon angioplasty with regression of symptoms after recanalization. With this report, we add a caveat about blockage of the ECA ostium during CAS.

Large arteriovenous malformation of the oromaxillofacial region with multiple phleboliths

Vascular tumors are the most common benign tumors of the head and neck in infancy and childhood. Vascular anomalies of the head and neck were divided into 2 categories including hemangiomas and vascular malformations. Oral and maxillofacial hemangiomas and vascular malformations are congenital lesions with various clinical characteristics, manifestations, indications, and possibilities for treatment. This paper reports a case of large arteriovenous malformations including a description of the features demonstrated by panoramic radiography, cone beam computed tomography, and magnetic resonance imaging. The differential diagnosis and treatment modalities (including embolization with N-butylcyanoacrylate in this case) are also discussed following the case presentation, along with the available literature review.

Pseudoaneurysm of the facial artery occurred after mandibular sagittal split ramus osteotomy

Introduction

Pseudoaneurysms are caused by rupture of arteries with extravasation of blood. The compressed perivascular tissue forms the wall of aneurysmal sac. Pseudoaneurysm directly related with surgical procedure of sagittal split ramus osteotomy (SSRO) was reported quite rarely especially related with facial artery during the vertical osteotomy.

Case report

SSRO was carried out for a 19-year-old male; the patient visited the emergency room with notable swelling 3 weeks after the surgery. We experienced severe intra-oral bleeding with surgical exploration. Angiography revealed a pseudoaneurysm of the right facial artery that might be related with vertical osteotomy over lateral cortex of the mandibular body during orthognathic surgery. This implies that the minor vascular trauma from vertical osteotomy of the mandibular body during the conventional orthognathic surgery might cause later development of pseudoaneurysm.