Transarterial embolization for traumatic intractable oronasal hemorrhage

Area of Science:

• Trauma Surgery
• Interventional Radiology
• Emergency Medicine

Background:

• Severe craniofacial injuries, often from high-energy impacts like motor vehicle collisions, can lead to intractable oronasal bleeding.
• This rare but critical condition presents a significant surgical emergency, with uncontrolled hemorrhage being a primary cause of mortality.
• Emergency Departments (EDs) are often the initial point of care for these complex trauma cases.

Observation:

• A 43-year-old male presented to the ED following a high-energy motor vehicle collision.
• The patient sustained severe craniofacial trauma, including intracranial hemorrhage and persistent, intractable oronasal bleeding.
• A pseudoaneurysm of the right internal maxillary artery was identified as the source of bleeding.

Findings:

• Endovascular treatment (EVT) via angiography was employed to diagnose the bleeding source.
• Transarterial embolization (TAE) was successfully performed to occlude the pseudoaneurysm and control the hemorrhage.
• The patient's intractable oronasal bleeding was effectively managed through this minimally invasive endovascular approach.

Implications:

• Endovascular treatment by TAE offers a viable and effective therapeutic option for managing intractable oronasal bleeding secondary to craniofacial trauma.
• This case highlights the importance of advanced imaging and interventional techniques in the ED for life-threatening bleeding emergencies.
• Successful EVT can prevent mortality and improve outcomes in patients with severe traumatic injuries.