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Hwang YR, Noh SY, Kwon SH, Oh JH. Successful Interventional Management of Common Carotid Artery Rupture during Recurrent Parathyroid Cancer Surgery: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:1128-1133. [PMID: 36276209 PMCID: PMC9574271 DOI: 10.3348/jksr.2021.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 11/30/2022]
Abstract
Common carotid artery (CCA) rupture during parathyroid cancer surgery is extremely rare and is generally life-threatening. We present a case of successful management of a ruptured CCA following the emergency placement of stent-graft in a 59-year-old male diagnosed with recurrent parathyroid cancer. During recurrent parathyroid cancer surgery, his right CCA ruptured unexpectedly, and his vital signs deteriorated rapidly despite surgical management. After stent replacement, his unstable vital signs improved and, thereafter, he was discharged without any complications.
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Lipe DN, Viets-Upchurch J, Hanna EY, Reyes-Gibby C, Chen SR, Elsayem A, Long B. Carotid Blowout Syndrome in the Emergency Department: A Case Report and Review of the Literature. J Emerg Med 2022; 62:e29-e34. [PMID: 35065858 DOI: 10.1016/j.jemermed.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/13/2021] [Accepted: 11/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Carotid blowout syndrome (CBS) is an infrequent but dangerous oncologic emergency that must be recognized due to a mortality rate that approaches 40% and neurologic morbidity that approaches 60%. Patients present with a variety of symptoms ranging from asymptomatic to frank hemorrhage, and appropriate recognition and management may improve their outcomes. CASE REPORT A man in his late 60s with squamous cell carcinoma of the oropharynx presented to the emergency department (ED) with hemoptysis and several episodes of post-tussive emesis with large clots. He had been cancer free for multiple years after treatment with chemotherapy and radiation to the neck. Evaluation revealed a necrotic tumor on the posterior pharynx on bedside laryngoscopy and an external carotid pseudoaneurysm that was stented by interventional radiology. The patient experienced recurrent hemorrhage several months later and opted for palliative measures and expired of massive hemorrhage in the ED on a subsequent visit. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: CBS can be fatal, and early suspicion and recognition are key to ensure that a threatened or impending carotid blowout are appropriately managed. Once carotid blowout is suspected, early resuscitation and consultation with interventional radiology and vascular surgery is warranted.
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Affiliation(s)
- Demis N Lipe
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jayne Viets-Upchurch
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cielito Reyes-Gibby
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen R Chen
- Interventional Radiology Department, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ahmed Elsayem
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
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Oh TS, Kwon JG, Jeong WS, Nam SY, Choi SH, Choi JW. A flag-shaped anterolateral thigh free flap for complete circumferential hypopharyngeal reconstruction with dead space obliteration and monitoring flap inset. J Plast Reconstr Aesthet Surg 2019; 72:1785-1794. [DOI: 10.1016/j.bjps.2019.05.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 04/09/2019] [Accepted: 05/15/2019] [Indexed: 02/08/2023]
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Gahleitner C, Hofauer B, Storck K, Knopf A. Outcome of carotid and subclavian blowout syndrome in patients with pharynx- and larynx carcinoma passing a standardized multidisciplinary treatment. Acta Otolaryngol 2018; 138:507-512. [PMID: 29310495 DOI: 10.1080/00016489.2017.1419575] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Carotid blowout syndrome (CBS) is one of the most feared emergencies in the head and neck surgery and tends to occur in patients with head and neck cancer, wound complications, pharyngocutaneous fistulas, or after radio(chemo)therapy. CBS is always life threatening and associated with a 50% mortality/morbidity rate. METHODS Between 2007 and 2015, a total of 51 patients who developed CBS caused by the tumour masses or after radio(chemo)therapy were included. All patients underwent a standardised bleeding management. RESULTS In 86% of patients, CBS was associated with manifest carcinoma. Fifty three percent of patients were treated by transcervical surgery, in 36% of these cases surgery was supplemented by endovascular approaches. Severe complications such as re-bleeding or cerebral ischemia occurred infrequently. Seven patients died because of the acute bleeding. CONCLUSION CBS associated with head and neck cancer carries poor mid and long-term prognoses. An interdisciplinary standardised treatment path dramatically reduced overall morbidity and mortality.
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Affiliation(s)
- Constanze Gahleitner
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Benedikt Hofauer
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Katharina Storck
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Andreas Knopf
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
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Vilas Boas PP, de Castro-Afonso LH, Monsignore LM, Nakiri GS, de Mello-Filho FV, Abud DG. Endovascular Management of Patients with Head and Neck Cancers Presenting with Acute Hemorrhage: A Single-Center Retrospective Study. Cardiovasc Intervent Radiol 2016; 40:510-519. [PMID: 27999918 DOI: 10.1007/s00270-016-1550-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/14/2016] [Indexed: 01/18/2023]
Abstract
PURPOSE Acute hemorrhage associated with cancers of the head and neck is a life-threatening condition that requires immediate action. The aim of this study was to assess the safety and efficacy of endovascular embolization for acute hemorrhage in patients with head and neck cancers. MATERIALS AND METHODS Data were retrospectively collected from patients with head and neck cancers who underwent endovascular embolization to treat acute hemorrhage. The primary endpoint was the rate of immediate control of hemorrhage during the first 24 h after embolization. The secondary endpoints were technical or clinical complications, rate of re-hemorrhage 24 h after the procedure, time from embolization to re-hemorrhage, hospitalization time, mortality rate, and time from embolization to death. RESULTS Fifty-one patients underwent endovascular embolization. The primary endpoint was achieved in 94% of patients. The rate of technical complications was 5.8%, and no clinical complication was observed. Twelve patients (23.5%) had hemorrhage recurrence after an average time of 127.5 days. The average hospitalization time was 7.4 days, the mortality rate during the follow-up period was 66.6%, and the average time from embolization to death was 132.5 days. CONCLUSION Endovascular embolization to treat acute hemorrhage in patients with head and neck cancers is a safe and effective method for the immediate control of hemorrhage and results in a high rate of hemorrhage control. Larger studies are necessary to determine which treatment strategy is best for improving patient outcomes.
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Affiliation(s)
- P P Vilas Boas
- Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14048-090, Brazil
| | - L H de Castro-Afonso
- Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14048-090, Brazil
| | - L M Monsignore
- Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14048-090, Brazil
| | - G S Nakiri
- Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14048-090, Brazil
| | - F V de Mello-Filho
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - D G Abud
- Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14048-090, Brazil.
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Scaglioni MF, Lin TS, Chen YC, Tsai YT, Yang CH, Wu CC, Kuo PJ, Hsieh CH, Yang JCS. The free inverted omega-shaped flap for circumferential hypopharyngeal reconstruction with simultaneous neck skin defect. Microsurgery 2016; 38:51-59. [PMID: 27062074 DOI: 10.1002/micr.30056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 03/16/2016] [Accepted: 03/23/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Circumferential hypopharyngeal defect with simultaneous skin defect can pose complicated reconstructive challenge for reconstructive microsurgeons. Our experience with the versatile inverted-omega flap tubing design is proposed to accommodate such problem. METHODS From 2012 to 2015, 13 anterolateral thigh (ALT) flaps and one anteromedial thigh (AMT) flap were harvested for reconstruction of circumferential hypopharyngeal defects with skin defects in 14 patients. All patients were males except one. Patient age ranged from 42 to 67 years (average, 53.1 years). Fifty-seven percent were recurrent cases. All but one patient received preoperative chemoradiotherapy. RESULTS The average flap size was 29 × 8 cm (range: 25-31 × 6-10 cm2 ). An average of 2.6 perforators was included in each flap (2-4 perforators/flap). All flaps survived. One venous thrombosis was noted and salvaged after thrombolectomy and vein graft. The mean follow-up period was 25 months. The fistula rate was 21.4% (three patients). One fistula never healed because of early recurrence; one fistula healed after surgical intervention; and one fistula need a loco-regional flap for secondary reconstruction. Three postoperative strictures were noted (21.4%). CONCLUSION For the circumferential hypopharyngeal defect with simultaneous neck skin defect, this inverted-omega ALT tubing design offers an alternative choice for such complicated reconstruction. © 2016 Wiley Periodicals, Inc. Microsurgery, 38:51-59, 2018.
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Affiliation(s)
- Mario F Scaglioni
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsan-Shiun Lin
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Chou Chen
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yun-Ta Tsai
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hsiang Yang
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Chung Wu
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pao-Jen Kuo
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Hsieh
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Johnson Chia-Shen Yang
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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