[Endovascular management of post-traumatic head and neck arteriovenous fistulas]

Endovascular treatment through the arterial or venous way is part of the management of diverse lesions in the head and neck, often as complementary of surgery, in highly vascularized tumors or single vascular lesions. Concerning the vascular pathology, the intra-arterial occlusive therapy can be used in some types of head and neck malformations, isolated or in association to surgery, to accomplish the complete removal of the "nidus" of the malformation, or for cosmetic purposes. Regarding the post traumatic arteriovenous fistulas, intra-arterial or intravenous embolization has been widely used and reported. The authors describe in this paper their experience with the endovascular management of carotid-cavernous post-traumatic fistulas, as well as with extracranial post traumatic a-v fistulas, related to the external carotid, vertebral and subclavian arterial branches. According to the location and type of the a-v shunt, several different strategies can be devised and diverse materials can be employed for embolization, like destacable microbaloons, cianocrilate, PVA particles and platin spirals. All the carotid-cavernous lesions were successfully occluded. In the extracranial lesions group, a successful result could not be obtained in one patient, who presented multiple a-v fistulas, and despite that he was clinically improved. In the present series of patients, only one case of cerebral thromboembolism was reported as a complication, with favourable outcome. Our overall results support the primary role played by the endovascular management in post-traumatic arteriovenous fistulas of the head and neck.