Article Figures & Data
Figures
- Fig 1.
A 24-year-old male patient who presented with intractable epistaxis after sagittal split ramus osteotomy. A, Lateral left ECA arteriogram shows a pseudoaneurysm at the internal maxillary artery segment at the pterygopalatine fossa. B, A microcatheter was advanced to the distal maxillary artery beyond the pseudoaneurysm that was embolized by using a coil. C, Selective injection of the left facial artery shows collaterals from the ascending artery to the distal maxillary artery via the infraorbital artery. Note the absence of filling of the pseudoaneurysm from retrograde flow of the distal maxillary artery.
- Fig 2.
A 19-year-old female patient who presented with intractable epistaxis after maxillofacial plastic surgery. A, An external carotid angiogram shows a large pseudoaneurysm (short thick arrows) and a fistula (long thin arrow) with an arteriovenous shunt. Note the early filling veins (short thin arrows). B, An angiogram obtained following coil embolization of the maxillary artery at the aneurysm site shows retrograde filling of the remaining shunt through the infraorbital artery (short thick arrows) via the facial artery and the zygomatico-orbital branch (short thin arrows) of the superficial temporal artery. C, An angiogram obtained the following day revealed a slightly smaller but still remaining fistula with persistent bleeding. Note the retrograde filling as indicated on B by the same arrows. D, The bleeding was finally controlled after additional coil embolization via the zygomatico-orbital branch (short thin arrows, B) into the fistula.
- Fig 3.
Endovascular treatment for recurrent bleeding approximately 2 months and 15 days after the initial embolization of the left ECA in a 45-year-old male patient with tonsil cancer. A, At the time of the first bleeding, the right facial and nearby maxillary arteries showing irregularities were regarded as the origin of the initial bleeding site and were embolized with coils as shown in B. B, Left common carotid arteriogram obtained at the time of the second bleeding reveals a tiny pseudoaneurysm (white arrow) in the proximal segment of the left superior thyroidal artery. Note the coils used in the previous embolization. C, Glue was used for embolization of the left superior thyroidal artery, and the final angiogram shows no residual pseudoaneurysm filling. The patient's bleeding was controlled thereafter.
- Fig 4.
A 51-year-old male patient with a history of supraglottic cancer who presented with massive bleeding at the ulcerative wound site in the right neck. After tracheostomy, he became drowsy and developed left-sided weakness in both the upper and lower extremities. A, A common carotid arteriogram shows extensive contrast leakage due to massive bleeding. No filling of the internal carotid artery from the common carotid artery (arrow) was seen. B, Bleeding was stopped following deployment of a covered stent. C, There is an occlusion of the right middle cerebral artery at the proximal M2 segment (arrow). D, Diffusion-weighted image obtained the next day shows a territorial infarct in the right MCA territory. E, CT scan obtained 17 months later shows the old infarction in the right middle cerebral artery territory, though the patient's weakness had improved and he walked without assistance.
