Endovascular approach to a ligated external carotid artery. Technical note

A 37-year-old female with left sided multiple congenital haemangiomata presented with repeated haemorrhage. The haemorrhagic origin was from the angiomatous lesion with arteriovenous (AV) shunting in the tongue and pharynx. The patient had already undergone ligation of the external carotid artery. Vascularization was mainly from the portion of the external carotid artery distal to the occlusion. Our first approach via the collateral channels to the haemangioma failed. Through direct puncture of the distal end of the external carotid artery with the use of two dimensional road mapping, we succeeded in catheterizing the distal end of the external carotid artery at the first attempt without placing any pressure on the neck, and carried out selective embolisation without mishap.