الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 115 |  |  |
| | | from | 115 | | |
Abstract
Although cervico-facial vascular lesions are a rare group of diseases, yet they have a wide pathological spectrum and their management is extremely challenging, so the presence of a multidisciplinary team is inevitable.
This study aimed to evaluate the role of combined CTA and DSA in the management of cervico-facial vascular lesions.
The study was carried out on 20 patients who were referred to the interventional radiology unit, preliminary diagnosed with cervico-facial vascular lesions and complaining from swelling, disfigurement or epistaxis. Demographic characteristics showed that 80% of patients were males and 20% were females. Regarding their age, 40% were 0 ≤ 20 years, 40% were 20 ≤ 40 and 20% were 40 ≤ 60 years.
All the patients were subjected to history taking, clinical examination and informed consent. Then all of them underwent multi-slice CTA including arterial and venous phases, as well as DSA.
CTA showed two main features; the first was tuft of tortuous feeding arteries and draining veins in patients with AVM and cirsoid aneurysm, and the second was a well-defend hyper-vascular mass in patients with JNA and carotid body tumor.
According to the decision of the MDT for each patient, the management plans included endovascular embolization as a final treatment in 20 % of the patients, endovascular embolization as a pre-operative procedure in 60% of the patients, and referred to surgery in 20% of the patients.
Endovascular embolization was done at the angiographic suite and two main embolic materials were used; particles (Embospheres) which were of choice in occlusion of JNAs, and histoacryl (glue) in occlusion of AVMs as well as cirsoid aneurysms. In the studied patients, half of them had AVMs, seven patients had JNAs, two patients had cirsoid aneurysms and a single patient had a CBT.
Different feeders were embolized in this study as the internal maxillary, facial and superficial temporal arteries were the most common involved feeders.
Eight patients had bilateral feeders especially with the midline lesions that warranted routine bilateral ECAs catheterization and endovascular embolization of the involved feeders to grantee adequate vascular lesion de-vascularization.
The CTA data were similar to the DSA results in 90% of the patients especially in delineation of the feeders of each vascular lesion except in a patient with a JNA, and other patient with a palatine AVM, in which the DSA revealed a small component supplied by the lesser palatine artery which was not depicted initially by the CTA.
The technical success was complete in 15 patients and partial in a single patient which was due to a very small tortuous accessory feeder that tried to be catheterized few times that led to an arterial vasospasm which was not relieved by nitroglycerine.
Only minor accepted complications happened as localized edema and pain which were easily managed.
Only two patients (one was with an AVM and the other with a JNA) came back with recurrent lesions after two years follow-up interval which were large lesions (> 7 cm). The recurrence was due to arterial recanalization or neovascularization, which was managed by re-embolization.
Surgical excision was done during the first 72 hours after embolization as it was the most accepted time interval for the surgeons for a less bloody operation.
Through two years interval, our patients were followed up clinically, and only two patients had recurrence which was managed by re-embolization.
This study reviewed the efficacy of combined CTA and DSA in managing cervico-facial vascular lesions, especially with the presence of the MDT without major complications.