Experience in Treating Traumatic Aneurysms (Pseudoaneurysms) of the Maxillary Artery Using Endovascular Techniques

Benik  Khasapetov; Andriy  Hresko; Serhiy  Vereshchagin; Andriy  Kopchak

doi:10.32345/USMYJ.4(150).2024.69-79

Benik Khasapetov Kyiv Regional Clinical Hospital No.1, Kyiv, Ukraine https://orcid.org/0009-0002-0088-1963
Andriy Hresko Kyiv City Clinical Hospital No.1, Kyiv, Ukraine https://orcid.org/0000-0002-1210-2536
Serhiy Vereshchagin Kyiv Regional Clinical Hospital No.1, Kyiv, Ukraine https://orcid.org/0000-0001-9302-6653
Andriy Kopchak Kyiv Regional Clinical Hospital No.1, Kyiv, Ukraine; Department of Maxillofacial Surgery and Modern Dental Technologies of the Postgraduate Education Institute, Bogomolets National Medical University, Kyiv, Ukraine https://orcid.org/0000-0002-3272-4658

DOI: https://doi.org/10.32345/USMYJ.4(150).2024.69-79

Keywords: Angiography; Endovascular procedures; Hemorrhage; Maxillary Artery; Pseudoaneurysm; Therapeutic Embolization; Stents; Wounds and Injuries

Abstract

Pseudoaneurysms, particularly of the maxillary artery, represent a significant clinical challenge due to their rarity and diagnostic complexity. Pseudoaneurysms arise from a breach in the arterial wall integrity, leading to a confined cavity filled with blood, which communicates with the arterial lumen but lacks the normal wall structure of the artery. These lesions are typically associated with trauma, surgical interventions, inflammatory processes, or atherosclerosis. Research shows that delayed diagnosis of pseudoaneurysms can lead to severe complications, such as massive hemorrhage or thromboembolic events. Due to the variability in symptoms, physicians must be aware of the clinical presentations and diagnostic tools that facilitate timely identification of this pathology.Objective:To present a detailed analysis of a clinical case involving a pseudoaneurysm of the maxillary artery that developed after surgical intervention. Main tasks:Describe the clinical case, Analyze diagnostic methods, Discuss treatment strategies, Evaluate treatment outcomes. In this study, we aim to demonstrate how early detection and appropriate treatment can significantly improve clinical outcomes and prevent complications. Various methods were used in the study, including clinical observation, review of the patient's medical records, and diagnostic techniques such as ultrasound (US), computed tomography with intravenous contrast (CT), and angiography. These methods enabled us to precisely visualize the pseudoaneurysm's structure and assess the extent of the lesion. Methods: Endovascular techniques were employed, representing a modern, minimally invasive approach to treating such conditions. These methods offer enhanced safety and faster recovery compared to traditional open surgical interventions. After conducting all necessary diagnostic procedures, we established an accurate diagnosis and developed a treatment plan. The patient underwent an endovascular intervention, which involved stenting of the pseudoaneurysm. Results: Significant improvement in the patient’s condition was observed within days of the procedure, with functional normalization and the absence of complications. These results highlight the importance of timely diagnosis and treatment in reducing the risk of severe outcomes. Conclusions: Our study emphasizes the need for clinicians to be aware of maxillary artery pseudoaneurysms. Early diagnosis can have a substantial impact on treatment outcomes. Endovascular methods have proven effective in treating pseudoaneurysms, offering new opportunities for therapy. However, further research is required to enhance therapeutic strategies, focusing on the mechanisms of this pathology's development and optimizing diagnostic approaches.

References

Ali, Z. A., Malis, D. D., & Wilson, J. W. (2007). Pseudoaneurysm of the maxillary artery after a stab wound treated by endovascular embolization. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 65(4), 790–794. https://doi.org/10.1016/j.joms.2005.11.070.

Amirjamshidi, A., Abbassioun, K., & Rahmat, H. (2000). Traumatic aneurysms and arteriovenous fistulas of the extracranial vessels in war injuries. Surgical neurology, 53(2), 136–145. https://doi.org/10.1016/s0090-3019(99)00181-0.

Banks, P., & Redpath, T. H. (1972). Closed carotid artery hemorrhage as a complication of minor gunshot wounds of the face and jaws. Journal of oral surgery (American Dental Association : 1965), 30(3), 176–183..

Clark, R., Lew, D., Giyanani, V. L., & Gerlock, A. (1987). False aneurysm complicating orthognathic surgery. Journal of oral and maxillofacial surgery, 45(1), 57-59..

Conner III, W. C. H., Rohrich, R. J., & Pollock, R. A. (1998). Traumatic aneurysms of the face and temple: a patient report and literature review, 1644 to 1998. Annals of plastic surgery, 41(3), 321-326.

Conner, W. C., 3rd, Rohrich, R. J., & Pollock, R. A. (1998). Traumatic aneurysms of the face and temple: a patient report and literature review, 1644 to 1998. Annals of plastic surgery, 41(3), 321–326. https://doi.org/10.1097/00000637-199809000-00019.

De Vogelaere K. (2004). Traumatic aneurysm of the superficial temporal artery: case report. The Journal of trauma, 57(2), 399–401. https://doi.org/10.1097/01.ta.0000052714.84144.d3

Dediol, E., Manojlovic, S., Biocic, J., Franceski, D., & Ivanac, G. (2011). Facial artery pseudoaneurysm without evidence of trauma. International journal of oral and maxillofacial surgery, 40(9), 988–990. https://doi.org/10.1016/j.ijom.2011.03.010.

Ditmars, M. L., Klein, S. R., & Bongard, F. S. (1997). Diagnosis and management of zone III carotid injuries. Injury, 28(8), 515–520. https://doi.org/10.1016/s0020-1383(97)00058-2.

Dunphy JE, Way LW. Current surgical diagnosis and treatment. 5th ed. Los Angeles: Lange Medical Publications; 1981.

El, A. S., Guo, W., Loveless, T., Dhaliwal, S. S., Quereshy, F. A., Baur, D. A., & Kaka, N. S. (2011). Pseudoaneurysm of the external carotid artery secondary to subcondylar fracture. International journal of oral and maxillofacial surgery, 40(6), 644–646. https://doi.org/10.1016/j.ijom.2010.11.022.

Feld, R., Patton, G. M., Carabasi, R. A., Alexander, A., Merton, D., & Needleman, L. (1992). Treatment of iatrogenic femoral artery injuries with ultrasound-guided compression. Journal of vascular surgery, 16(6), 832–840. https://doi.org/10.1067/mva.1992.41519

Feliciano, D. V., Cruse, P. A., Burch, J. M., & Bitondo, C. G. (1987). Delayed diagnosis of arterial injuries. American journal of surgery, 154(6), 579–584. https://doi.org/10.1016/0002-9610(87)90220-0

Ferris, E. J., Shapiro, J. H., Roth, D. A., & Bub, B. (1967). Superficial temporal artery aneurysms. Radiology, 88(2), 268–270. https://doi.org/10.1148/88.2.268

Gerbino, G., Roccia, F., Grosso, M., & Regge, D. (1997). Pseudoaneurysm of the internal maxillary artery and Frey's syndrome after blunt facial trauma. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 55(12), 1485–1490. https://doi.org/10.1016/s0278-2391(97)90657-1.

Germiller, J. A., Myers, L. L., Harris, M. O., & Bradford, C. R. (2001). Pseudoaneurysm of the proximal facial artery presenting as oropharyngeal hemorrhage. Head & Neck: Journal for the Sciences and Specialties of the Head and Neck, 23(3), 259-263.

Golden, G. T., Fox, J. W., Williams, G. S., & Edgerton, M. T. (1975). Traumatic aneurysm of the superficial temporal artery. Squash-ball disease. JAMA, 234(5), 517–518.

Hamdan, A. L., Fuleihan, N., & Shreif, J. (2000). False aneurysm after rhinoplasty: an unusual complication. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 122(6), 923–925. https://doi.org/10.1067/mhn.2000.104668

Hertzer N. R. (2000). Extracranial carotid aneurysms: a new look at an old problem. Journal of vascular surgery, 31(4), 823–825. https://doi.org/10.1067/mva.2000.105675.

Hresko, A., Chernogorskyi, D., Vereshchagin, S., & Kopchak, A. (2018). Endovascular embolization of facial artery pseudoaneurysm following lancing of a subperiosteal abscess: case report.

Karas, D. E., Sawin, R. S., & Sie, K. C. (1997). Pseudoaneursym of the external carotid artery after tonsillectomy. A rare complication. Archives of otolaryngology--head & neck surgery, 123(3), 345–347. https://doi.org/10.1001/archotol.1997.01900030133017.

Kazmers, A., Meeker, C., Nofz, K., Kline, R., Groehn, H., Oust, G., Abson, K., Cocking, K., Despriet, S., & Krause, M. (1997). Nonoperative therapy for postcatheterization femoral artery pseudoaneurysms. The American surgeon, 63(2), 199–204.

Kennedy, J. W., & Kent, J. N. (1970). False aneurysm and a partial facial paralysis secondary to mandibular fracture: report of case. Journal of oral surgery (American Dental Association : 1965), 28(11), 854–856.

Kornbrot, A., Shaw, A. S., & Toohey, M. R. (1991). Pseudoaneurysm as a complication of arthroscopy: a case report. Journal of oral and maxillofacial surgery, 49(11), 1226-1228.

Kraus, R. R., Bergstein, J. M., & DeBord, J. R. (1999). Diagnosis, treatment, and outcome of blunt carotid arterial injuries. American journal of surgery, 178(3), 190–193. https://doi.org/10.1016/s0002-9610(99)00157-9.

Krishnan, D. G., Marashi, A., & Malik, A. (2004). Pseudoaneurysm of internal maxillary artery secondary to gunshot wound managed by endovascular technique. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 62(4), 500–502. https://doi.org/10.1016/j.joms.2003.05.018.

Lanigan, D. T., Hey, J. H., & West, R. A. (1990). Major vascular complications of orthognathic surgery: hemorrhage associated with Le Fort I osteotomies. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 48(6), 561–573. https://doi.org/10.1016/s0278-2391(10)80468-9.

Lanigan, D. T., Hey, J. H., & West, R. A. (1991). Major vascular complications of orthognathic surgery: false aneurysms and arteriovenous fistulas following orthognathic surgery. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 49(6), 571–577. https://doi.org/10.1016/0278-2391(91)90337-l.

Lönn, L., Olmarker, A., Geterud, K., & Risberg, B. (2004). Prospective randomized study comparing ultrasound-guided thrombin injection to compression in the treatment of femoral pseudoaneurysms. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, 11(5), 570–576. https://doi.org/10.1583/03-1181.1

Marco de Lucas, E., Gutiérrez, A., González Mandly, A., García-Pire, F., Marco de Lucas, M. T., Parra, J. A., & Sáiz-Bustillo, R. (2008). Life-threatening pseudoaneurysm of the facial artery after dental extraction: successful treatment with emergent endovascular embolization. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics, 106(1), 129–132. https://doi.org/10.1016/j.tripleo.2007.09.031.

Martinod, E., Warnier, G., Aupecle, B., Lajos, P., Chapuis, O., Pons, F., Azorin, J. F., & Jancovici, R. (1999). False aneurysm of the left common carotid artery 52 years after penetrating injury of the chest. The Journal of trauma, 47(2), 400–402. https://doi.org/10.1097/00005373-199908000-00035.

Minion, D. J., Lynch, T. G., Baxter, B. T., & Lieberman, R. (1994). Pseudoaneurysm of the external carotid artery following radical neck dissection and irradiation: a case report and review of the literature. Cardiovascular surgery (London, England), 2(5), 607–611.

Nadig, S., Barnwell, S., & Wax, M. K. (2009). Pseudoaneurysm of the external carotid artery--review of literature. Head & neck, 31(1), 136–139. https://doi.org/10.1002/hed.20855.

O’Brian CE. An unusual complication following facial trauma. Int J Oral Surgery 1981;10(suppl):241.

Partridge, E., Zwirewich, C. V., & Salvian, A. J. (1995). Facial artery pseudoaneurysm: diagnosis by colour Doppler ultrasonography. Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes, 46(6), 458–460.

Peoples, J. R., 3rd, Herbosa, E. G., & Dion, J. (1988). Management of internal maxillary artery hemorrhage from temporomandibular joint surgery via selective embolization. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 46(11), 1005–1007. https://doi.org/10.1016/0278-2391(88)90340-0

PETITTI, L., & JENNINGS, H. B., Jr (1952). False aneurysm of the facial artery. United States Armed Forces medical journal, 3(5), 781–784.

Piccioni, A., Vaccaro, V., Manca, F., Nonno, C., Zanza, C., Savioli, G., Candelli, M., Covino, M., & Franceschi, F. (2022). Management of maxillary artery pseudoaneurysm in Emergency Department: a narrative review. La Clinica terapeutica, 173(5), 496–499. https://doi.org/10.7417/CT.2022.2468

Ramsay, D. W., & McAuliffe, W. (2003). Traumatic pseudoaneurysm and high flow arteriovenous fistula involving internal jugular vein and common carotid artery. Treatment with covered stent and embolization. Australasian radiology, 47(2), 177–180. https://doi.org/10.1046/j.0004-8461.2003.01147.x.

Rayati, F., Parsa, H., Abed, P. F., & Karagah, T. (2010). Facial artery pseudoaneurysm following surgical removal of a mandibular molar. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 68(7), 1683–1685. https://doi.org/10.1016/j.joms.2009.07.078.

Ricci, M. A., Trevisani, G. T., & Pilcher, D. B. (1994). Vascular complications of cardiac catheterization. American journal of surgery, 167(4), 375–378. https://doi.org/10.1016/0002-9610(94)90119-8

Rich, N. M., & Spencer, F. C. (1978). Vascular trauma. Philadelphia etc. Saunders Co.

Rich, N. M., Hobson, R. W., 2nd, & Collins, G. J., Jr (1975). Traumatic arteriovenous fistulas and false aneurysms: a review of 558 lesions. Surgery, 78(6), 817–828.

Silva, A. C., O'Ryan, F., Beckley, M. L., Young, H. Y., & Poor, D. (2007). Pseudoaneurysm of a branch of the maxillary artery following mandibular sagittal split ramus osteotomy: case report and review of the literature. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 65(9), 1807–1816. https://doi.org/10.1016/j.joms.2005.12.040

van den Akker, H. P., & van der Lijn, F. (1974). A false aneurysm of the facial artery as a complication of circumferential wiring. Oral surgery, oral medicine, and oral pathology, 37(4), 514–517. https://doi.org/10.1016/0030-4220(74)90281-3.

Yuen, J. C., & Gray, D. J. (2000). Endovascular treatment of a pseudoaneurysm of a recipient external carotid artery following radiation and free tissue transfer. Annals of plastic surgery, 44(6), 656–659. https://doi.org/10.1097/00000637-200044060-00015.

Zachariades, N., Rallis, G., Papademetriou, G., Papakosta, V., Spanomichos, G., & Souelem, M. (2001). Embolization for the treatment of pseudoaneurysm and transection of facial vessels. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics, 92(5), 491–494. https://doi.org/10.1067/moe.2001.117453.

Zachariades, N., Skoura, C., Mezitis, M., & Marouan, S. (2000). Pseudoaneurysm after a routine transbuccal approach for bone screw placement. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 58(6), 671–673. https://doi.org/10.1016/s0278-2391(00)90165-4.