Successful facial artery pseudoaneurysm coiling and pedicle preservation following free tissue transfer

Publication date: Available online 28 September 2016
Source:American Journal of Otolaryngology
Author(s): Andrew T. Day, Dane J. Genther, Ferdinand Hui, Wojciech K. Mydlarz, Gillian Griffith, Shaun C. Desai
Patients who develop delayed neck hemorrhage or a pulsatile neck mass after free flap reconstruction should be evaluated for an anastamotic pseudoaneurysm, especially in the setting of previous radiation, infection, trauma, and systemic hypertension. Management strategies for head and neck pseudoaneurysms have included open vessel ligation, open direct vessel repair, endovascular parent vessel embolization, and, most recently, endovascular pseudoaneurysm embolization. In patients with anastamotic pseudoaneurysms where adequate flap inosculation is doubted, endovascular pseudoaneurysm embolization with pedicle preservation may be an appropriate primary treatment approach. We present the first case of successful endovascular pseudoaneurysm coiling of an external carotid artery branch anastamotic pseudoaneurysm in a previously-radiated, elderly patient one month after tubed anterolateral thigh flap reconstruction of a total laryngopharyngectomy and partial glossectomy defect complicated by pharyngocutaneous fistula.



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