Role of CT and Endovascular Embolization in Managing Pseudoaneurysms of the Internal Maxillary Artery

Abstract

The purpose of this study was to evaluate the role of computed tomography (CT) and endovascular embolization in managing 10 patients with 11 internal maxillary arterial pseudoaneurysms (IMPAs) with acute oronasal hemorrhage. A series of 10 patients with 11 IMPAs presenting with profuse oronasal hemorrhage, all treated with endovascular embolization, were reviewed. There were 9 males and 1 female ranging in age from 10 to 56 years (mean, 38 years). The predisposing factors of IMPA were trauma (n = 6) or head and neck carcinomas (HNCs) after surgical treatment and/ or postradiation therapy (n = 5). Before embolization, all patients had CT of maxillofacial regions to evaluate the extension of trauma or to evaluate the treatment outcome for HNCs. Endovascular embolization was employed-to occlude the IMPAs by delivering the embolic agents of liquid adhesives (n = 9) or microcoils (n = 2) to the IMPAs. On the lesion side, CT revealed maxillofacial fractures in all 5 trauma patients and recurrent or residual tumors in 3 patients with HNCs. In the other 2 patients with HNCs, CT showed no significant finding and contributed little to the catheter angiography in detecting the IMPAs. Endovascular treatment was technically successful in all 11 IMPAs, ceasing hemorrhage immediately after embolization. No recurrence of bleeding was observed. No patient developed neurologic deficit, skin, or mucosal necrosis at the maxillofacial region. Clinical follow-up was 2-36 months (mean, 14 months). Two patients with advanced carcinoma died during follow-up because of disease progression. CT is a useful tool for guiding catheter angiography to localize the majority of IMPAs. Endovascular embolization can succeed in managing IMPAs, and should be performed as soon as the IMPA is depicted.