Turkish Neurosurgery 2018 , Vol 28 , Num 1
Endovascular Management of Iatrogenic Vascular Injury in the Craniocervical Region
Elcin AYDIN1,Mustafa GOK2,Asim ESENKAYA3,Celal CINAR4,Ismail ORAN4
1Bakent University, Department of Radiology, Izmir, Turkey
2Adnan Menderes University, Department of Radiology, Aydn, Turkey
3Trakya University, Department of Radiology, Edirne, Turkey
4Ege University, Department of Radiology, Izmir, Turkey
DOI : 10.5137/1019-5149.JTN.18189-16.1 AIM: To evaluate iatrogenic vascular injuries in the craniocervical region and their endovascular management.

MATERIAL and METHODS: Twenty-one patients (9 women, 12 men) with a mean age of 53.6 years (range 16-87 years), who underwent endovascular embolization for iatrogenic vascular injury in the craniocervical region between December 2000 and October 2015, were included in this retrospective study. Types of iatrogenic injuries, etiologies that caused these injuries and details of endovascular managements were reported.

RESULTS: The etiologies of the vascular injuries were as follows: transsphenoidal surgery (n=9), skull-base surgery (n=2), cholesteatoma surgery (n=1), tracheostomy (n=2), central venous catheterization (n=2), oropharyngeal tumor operation (n=1), endovascular treatment of internal carotid artery (ICA) stenosis (n=1), suprasellar epidermoid tumor operation (n=1), sphenoid sinus tumor surgery (n=1), and speech prosthesis device placement (n=1). The types of vascular injuries diagnosed at the time of angiography were; 2 occlusions, 2 stenoses, 2 dissections, 1 carotid cavernous fistula, 8 artery rupture with extravasation, and 9 pseudoaneurysms. Endovascular management of these vascular injuries were; parent artery occlusion (PAO) (n=15), aneurysm occlusion (n=3), covered stent (n=1) and conservative management (n=2). All patients except two were successfully treated. No patient had bleeding within a 30-day period after angiography. Long-term follow-up was available in all patients without occurrence of re-bleeding. One patient died due to complications related to primary vascular injury.

CONCLUSION: Although iatrogenic vascular injuries are rare, early diagnosis and management may be lifesaving. Endovascular techniques are reliable and safe in most of the patients. Keywords : Endovascular management, Iatrogenic injury, Craniocervical region

Corresponding author : Elcin AYDIN, elcinaydin09@yahoo.com.tr