Endovascular treatment of a pseudoaneurysm of a recipient external carotidartery following radiation and free tissue transfer

Radical resection and reconstruction after preoperative radiation has becom e routine treatment for patients with certain types and stages of head and neck cancers. When microvascular flap reconstruction is required, the recip ient vessels have been subjected to radiation, making them more thrombogeni c and friable, thus increasing the risks of postoperative complications. Th e authors report a patient who received preoperative radiation therapy for rhabdomyosarcoma of the infratemporal fossa and who underwent a radical res ection and free rectus musculocutaneous flap reconstruction. The free flap covered the base of the brain from the nasopharynx and closed an intraoral defect. The donor artery was anastomosed end to side to the external caroti d artery stump. The patient developed a pseudoaneurysm of the external caro tid artery stump 1 month postoperatively, which was treated with endovascul ar coil embolization without loss of the flap. Percutaneous transcatheter e ndovascular treatment of pseudoaneurysms that develop after free tissue tra nsfer in head and neck reconstruction has not been reported previously. One month after surgery, endovascular occlusion of the main arterial supply to the flap did not compromise its viability because of collateral revascular ization from the peripheral tissue bed, despite the patient's history of ra diation.