Endovascular management of iatrogenic vascular injury in craniocervical region

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therapeutic procedure responsible for the injury, i.e. transsphenoidal surgery (TSS), skull base surgery, tumor surgery, tracheostomy, central venous catheterization (CVC), speech prosthesis device placement procedure.The mechanisms of injuries, and procedures were discussed for each type of procedure.The type of iatrogenic vascular injury mostly depends on the type of procedure.Although iatrogenic vascular injuries in the craniocervical region are rare, they are usually fatal █ INTRODuCTION I atrogenic vascular injury in the craniocervical region results from various diagnostic and therapeutic procedures.The objective of this article is to provide an update on the mechanism of injury and endovascular management of this potentially devastating complication.Iatrogenic vascular injuries were categorized according to each diagnostic or 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.

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