Shivanand Gamanagatti1, Thotton Veedu Prasad2, Atin Kumar2, Maneesh Singhal3, Sushma Sagar3. 1. Department of Radiology, Jai Prakash Narayan Apex Trauma Center, All India Institute of Radiodiagnosis (AIIMS), Ansari Nagar, New Delhi, 110029 India ; Department of Radiology, JPNA TC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029 India. 2. Department of Radiology, Jai Prakash Narayan Apex Trauma Center, All India Institute of Radiodiagnosis (AIIMS), Ansari Nagar, New Delhi, 110029 India. 3. Department of Surgery, All India Institute of Radiodiagnosis (AIIMS), Ansari Nagar, New Delhi, 110029 India.
Abstract
PURPOSE: To analyze the safety, efficacy and outcome of angio-embolization in the management of refractory oro-nasal bleeding in patients of severe maxillofacial trauma. MATERIALS AND METHODS: It was a retrospective analysis of 21 patients who were managed by angio-embolisation to control refractory oro-nasal bleeding in severe maxillofacial trauma from December 2010 to December 2013. The patient population included 19 males and 2 females and the age ranged from 16 to 55 years (mean age of 29.6 years). Gelfoam pledgets and coils were used as embolising agents in branches of external carotid arteries. Embolising coils were preferably used to block actively bleeding vessels on angiography. RESULTS: Road traffic accidents were the etiology in 17 patients and fall from height (two), assault (one) and gunshot injury (one) in the rest. Twelve (52 %) patients showed active contrast extravasation on angiography. Active arterial bleeding was observed from branches of internal maxillary [11], facial [2] and lingual arteries [4]. Gel foam embolisation alone was done in 16 patients, coil embolisation alone in two patients and both coil and gel foam embolisation in three patients. The procedures were technically successful in twenty (95 %) patients. None of the patients had procedure related complications. Nine patients (42 %) succumbed to their associated injuries later, in which five patients had severe head injuries and four patients had history of hemorrhagic shock and cardiac arrest prior to the procedure. CONCLUSION: Angio-embolisation is a safe and effective technique in managing intractable bleeding in maxillofacial injuries.
PURPOSE: To analyze the safety, efficacy and outcome of angio-embolization in the management of refractory oro-nasal bleeding in patients of severe maxillofacial trauma. MATERIALS AND METHODS: It was a retrospective analysis of 21 patients who were managed by angio-embolisation to control refractory oro-nasal bleeding in severe maxillofacial trauma from December 2010 to December 2013. The patient population included 19 males and 2 females and the age ranged from 16 to 55 years (mean age of 29.6 years). Gelfoam pledgets and coils were used as embolising agents in branches of external carotid arteries. Embolising coils were preferably used to block actively bleeding vessels on angiography. RESULTS: Road traffic accidents were the etiology in 17 patients and fall from height (two), assault (one) and gunshot injury (one) in the rest. Twelve (52 %) patients showed active contrast extravasation on angiography. Active arterial bleeding was observed from branches of internal maxillary [11], facial [2] and lingual arteries [4]. Gel foam embolisation alone was done in 16 patients, coil embolisation alone in two patients and both coil and gel foam embolisation in three patients. The procedures were technically successful in twenty (95 %) patients. None of the patients had procedure related complications. Nine patients (42 %) succumbed to their associated injuries later, in which five patients had severe head injuries and four patients had history of hemorrhagic shock and cardiac arrest prior to the procedure. CONCLUSION: Angio-embolisation is a safe and effective technique in managing intractable bleeding in maxillofacial injuries.
Authors: David A Cardenas; Cristian G García; Cristhian García; Jose L Moreno; Milton O Sandoval; Dorian I Villafuerte Journal: Trauma Case Rep Date: 2021-02-10