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Online ISSN 1827-1847
Menegolo M. 1, Piazza M. 1, Frigatti P. 2, Grego F. 2, Antonello M. 1
1 Section of Vascular and Endovascular Surgery Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy;
2 Vascular Surgery, Santa Maria della Misericordia Hospital, Udine, Italy
This is a two cases experience in use of covered stent as an adjunctive procedure to reduce intraoperative bleeding in large neck paragangliomas. Two patients affected by large cervical paragangliomas (vagal tumor and carotid body tumor) underwent a selective carotid angiography to map accurately all the main vessels nourishing the tumor and plan the endovascular pre-surgical treatment. In both patients was detected a main vessel arising from a distal branch of external carotid artery and feeding the upper pole of the mass while several vessels arising from proximal external carotid artery fed the lower part of the tumor. The day before surgery in both patients, all these nourishing vessels were excluded by positioning of covered stents in external carotid artery and in one of its distal branches; the subsequent surgical excision was uneventful, with a small amount of intra-operative blood loss (<100 mL). In one patient the left vagus nerve was sacrificed to obtain radical excision of the tumour. This approach appears to be a valid alternative to conventional embolization in reducing intraoperative blood loss for large neck paragangliomas, moreover the risk of periprocedural stroke seems to be abolished.