Facial Artery Aneurysms: A Systematic Review of Characteristics, Therapeutic Interventions, and Clinical Results

Facial artery aneurysms are rare vascular anomalies that may manifest as pseudoaneurysms following trauma or iatrogenic injury or as true aneurysms due to vascular degeneration. This systematic review aims to summarize the available evidence on the diagnosis, management, and complications of these lesions to guide clinical decision-making.

A comprehensive search of PubMed, Scopus, and Web of Science was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant case reports, case series, and observational studies published up to October 2024 were included. Data extraction focused on patient demographics, aneurysm characteristics, diagnostic modalities, treatment approaches, and clinical outcomes.

Seventy studies reporting on 74 patients with a mean age of 35 years met the inclusion criteria. Iatrogenic events, particularly post-tonsillectomy, accounted for approximately 39% of cases, while trauma was responsible for 36%. Pseudoaneurysms constituted the majority of lesions. Treatment strategies included surgical removal, endovascular embolization, combined techniques, and conservative management. Surgical intervention demonstrated a high success rate with minimal complications (3.8% complication rate), whereas endovascular procedures were associated with a higher incidence of adverse events (21.4% complication rate), including embolic events and coil extrusion. No standardized management approach was identified, highlighting the need for individualized treatment decisions based on lesion size, location, and patient-specific factors.

Facial artery aneurysms, though rare, require timely diagnosis and tailored management strategies. Surgical intervention appears to offer a favorable outcome with fewer complications compared to endovascular techniques. However, the findings are limited by the reliance on case reports and small sample sizes, which may introduce selection and publication bias. Clinical implications include the need for careful risk-benefit assessment when selecting endovascular approaches. Future large-scale observational studies or trials are needed to establish standardized guidelines.

The online version contains supplementary material available at 10.1007/s12663-025-02716-9.