Turkish Neurosurgery
Endovascular Management of Iatrogenic Vascular Injury in Craniocervical Region
elçin aydın1, Mustafa Gök2, Asım Esenkaya4, Celal Çınar3, İsmail Oran3
1başkent University, radiology, izmir,
2Adnan Menderes University, radiology, Aydın,
3Ege University, radiology, izmir,
4Trakya University, radiology, Edirne,
DOI: 10.5137/1019-5149.JTN.18189-16.1

Aim:We aimed to evaluate iatrogenic vascular injuries in craniocervical region and their endovascular management. Material and Methods:Twenty-one patients (nine women, twelve men) with a mean age of 53.6 (range 16-87 years), who underwent endovascular embolization for iatrogenic vascular injury in 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), oropharyngial 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 prostehesis device placement (n=1). The types of vascular injuries diagnosed at the time of angiography were; 2 occlusions, 2 stenosis, 2 dissections, 1 carotid cavernous fistula, 8 artery rupture with extravasation, 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. All patients didn\'t have bleeding within 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. The endovascular techniques are reliable and safe in most of the patients.

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