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Ear, nose and throat
Endovascular repair of radial artery non-anastomotic pseudoaneurysm in a radial forearm free flap
  1. Dylan J Cooper1,
  2. Joseph T Tarr2,
  3. Raphael Sacho3,
  4. Michael A Blasco1 and
  5. Marilyn Ng4
  1. 1Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, New York, USA
  2. 2Department of Plastic Surgery, Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, New York, USA
  3. 3Department of Neurosurgery, Staten Island University Hospital, Staten Island, New York, USA
  4. 4Division of Plastic and Reconstructive Surgery, Staten Island University Hospital, Staten Island, New York, USA
  1. Correspondence to Dr Dylan J Cooper; dcooper12{at}northwell.edu

Abstract

The development of pseudoaneurysm is an uncommon, life-threatening complication of head and neck microvascular surgery. Only a handful of reports have been published describing microvascular pseudoaneurysms, which usually occur at the arterial anastomosis and present as a pulsatile neck mass or as haemorrhage in case of pseudoaneurysm rupture. Management is highly variable, especially in the acute setting. In patients with pseudoaneurysm where flap inosculation is inadequate, endovascular approaches may be appropriate. In this report, we describe a ruptured distal pedicle pseudoaneurysm of a radial forearm free flap salvaged with a flow-diverting stent with complete flap survival and pedicle preservation. We demonstrate further evidence and feasibility of endovascular treatment of a non-anastomotic pseudoaneurysm arising from small vessels when parent vascular integrity is critical to flap survival.

  • Ear, nose and throat
  • Neuroimaging
  • Neuro ITU
  • Clinical neurophysiology
  • Head and neck surgery

http://dx.doi.org/10.1136/bcr-2023-256588

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    Footnotes

    • Twitter @dylanjcoop

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: DC, JT, MB. The following authors gave final approval of the manuscript: RS, MN.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.