Digital scan to erase the background and vascular malformations in the head, face and neck area

This article is professionally consulted by Dr. Pham Quoc Thanh - Radiologist - Department of Diagnostic Imaging - Vinmec Hai Phong International General Hospital.

1.1. Definition The majority of head and neck vascular malformations arise from the external carotid artery, which is the main artery of the head and neck, or can also be caused by the internal carotid arteries, or the vertebral arteries. , which is also the great artery in the neck.
Vascular malformation of the head, face and neck is a very complicated treatment because it requires the coordination of many different specialties. Treatment usually involves endovascular intervention, or direct puncture of the malformation, followed by temporary or permanent embolization by injecting material. This method can help cure completely, or reduce the size of the focal malformation, or it can also reduce the perfusion to the malformation. In order to completely treat the disease, it may be necessary to combine surgery or sclerotherapy.
1.2. Indications and contraindications * Indications
Embolization for treatment of head and neck vascular malformations: arteriovenous catheterization, pseudoaneurysm.. Embolization reduces tumor size. Angioplasty to prepare for surgery. benefits (reduces bleeding, more radical surgery...) Embolization treats bleeding lesions to stop bleeding: trauma, tumor invades blood vessel necrosis causing bleeding... Embolization Tumor treatment with angiogenesis * Contraindication
No absolute contraindication Relative contraindications in case of coagulopathy, renal failure, clear allergy history, pregnancy .

1.3. Treatment method The method of treating vascular malformation in the head, face and neck area under the guidance of digital background erasure is a new option today.
Endovascular access is performed by inserting intravascular instruments to the malformation and then injecting the embolization agent.
In recent years embolization has been shown to be a better, simpler and more effective option for the treatment of acute bleeding tumors in general and head and neck tumors in particular.

2.1. Executor Specialist Specialist Assistant Doctor Electro-optical technician Nursing Doctor, anesthesiologist (if the patient cannot cooperate) 2.2. Means Digital angiography machine DSA background eraser Specialized electric pump Film, film printer, image storage system Lead jacket, apron, X-ray shielding 2.3. Medicines Local anesthetics General anesthetics (if there is an indication for anesthesia) Anticoagulants Neutralizing anticoagulants Water-soluble iodine contrast agents Skin and mucosal antiseptic solutions 2.4. General medical supplies Syringe 1; 3; 5; 10ml Syringe for electric pump Distilled water or physiological saline Gloves, gown, cap, surgical mask Aseptic intervention kit: knife, scissors, tongs, 4 metal bowls, bean tray, tray Cotton, gauze, surgical adhesive tape. Medicine box and first aid kit for contrast drug accidents. 2.5. Special medical supplies Angioplasty needle 5-6F Catheter Set Standard Lead 0.035inch Angiography Catheter 4-5F Microcatheter 1.9-3F Micro Lead 0.014-0.018inch Catheter 6F Set Y-connector.

2.6. Materials that cause embolism Bio-foam (gelfoam) Synthetic plastic beads (PVA) Bio-glue (Histoacryl, Onyx...) Metal spirals of all sizes (coils) 2.7. Patients Patients are carefully explained about the procedure to coordinate with the doctor. Need to fast, drink before 6 hours. Can drink no more than 50ml of water. In the intervention room: the patient lies on his back, fitted with a monitor to monitor breathing, pulse, blood pressure, electrocardiogram, SpO2. Disinfect the skin, then cover with a sterile, perforated cloth. The patient is too excited, can't lie still: need to give sedation... 2.8. Test sheet Medical record for inpatient treatment There is an approved order to perform the procedure. X-ray, CT scan, MRI (if any).

3.1. Anesthesia method General anesthesia or local anesthesia. The patient lies supine on the imaging table, intravenous line is placed (usually 0.9 % isotonic saline serum is used), pre-anesthesia is injected, with the exception of young children (under 5 years old) who are not yet conscious or cooperative. overstimulated fear requiring general anesthesia for procedure
3.2. Selecting the catheter approach and access route Using the Seldinger technique, the catheter entry routes can be: from the femoral artery, axillary artery, brachial artery, the carotid artery, and the radial artery.
Usually mostly from the femoral artery, unless this is not possible, other routes of entry are used
3.3. Diagnostic angiography Disinfection and anesthesia of the puncture site Needle puncture and catheterization For selective angiography of the internal carotid artery: insert an arterial catheter through the catheter onto the carotid artery in the contrast pump through the machine with a volume of 10ml, speed 4ml/s, pressure 500 PSI. Batch imaging and imaging focused on the skull in a straight, fully tilted, and 45 degree oblique position. For selective angiography of the external carotid artery: insert an arterial catheter into the external carotid artery and inject contrast agent through the machine with a volume of 8 ml, a rate of 3 ml/s, and a pressure of 500 PSI. Batch imaging and imaging focused on the skull in a fully upright and tilted position. For selective vertebral artery angiography: insert a Vertebral 4-5F catheter, into the vertebral artery (usually on the left), inject contrast agent, with a volume of 8ml, rate of 3ml/s, pressure of 500PSI. Mass imaging and radiography focused on posterior fossa cranial fossa in full tilt and upright position with shadow 25-degree oblique, and 45-degree oblique position. 3D imaging can be performed depending on the pathology 3.5. Embolization Insertion of a catheter into a common gill vessel into the lateral-maxillary carotid artery Microcatheterization of the malformed vessel or artery causing the bleeding Injecting embolized material: depending on the characteristics and location of the lesion Trade, choose different materials. Temporary plug materials (PVA, Spongel, Hemostatic foam), permanent plug materials (Histoacryl glue, Onyx, Metal spiral ..) After satisfactory scan, remove catheter, remove catheter out of the lumen, apply manual pressure directly on the needle puncture site for about 15 minutes to stop bleeding, then apply pressure for 8 hours.

Arteriovenous malformations and feeding arteries are completely or partially occluded, with no venous drainage. The arteries that supply blood to normal organs are not blocked.

5.1. During the procedure Due to the procedure: laceration of the artery causing bleeding, or dissection of the artery, managed by stopping the procedure, applying manual pressure and re-applying, if the bleeding stops, it can be done again after 1-2 weeks. Due to contrast agents: see also the procedure of Diagnosis and management of contrast agent complications. Vasospasm: Depending on the severity, a selective vasodilator pump can be performed. 5.2. After the procedure, the catheter site may bleed or have a hematoma, which should be bandaged and kept immobile until the bleeding stops. In case of suspected arterial occlusion due to blood clot or embolism due to detachment of atherosclerotic plaques (rare) requires prompt medical examination and treatment by a specialist. In the event of an arteriovenous bulge or patency, a ruptured catheter or lead (rarely) can be treated surgically. In case of infection after the procedure, antibiotics are needed to treat it. Some other rare complications: embolization, paralysis, blindness, pharyngeal and pharyngeal necrosis, tooth failure... need specialist consultation.

Vinmec International General Hospital has applied digital imaging technology to erase the background in examination and diagnosis of many diseases. Accordingly, the digital background removal technique at Vinmec is carried out methodically and in accordance with the process standards by a team of highly qualified medical professionals and modern machinery, thus giving accurate results, contributing to plays an important role in determining the disease and the stage of the disease.
Master. Doctor. Pham Quoc Thanh has received intensive training and participated in many national and international scientific conferences on diagnostic imaging. The doctor has 13 years of experience in the field of diagnostic imaging and is currently a doctor at the Department of Diagnostic Imaging, Vinmec Hai Phong International General Hospital.