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Leboucher A, Sotton S, Gambin Flandrin I, Magné N. Head and neck radiotherapy-induced carotid toxicity: Pathophysiological concepts and clinical syndromes. Oral Oncol 2022; 129:105868. [DOI: 10.1016/j.oraloncology.2022.105868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 03/27/2022] [Accepted: 04/12/2022] [Indexed: 01/17/2023]
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Mitchell RB, Pereira KD, Lazar RH, Long TE, Fournier NF. Pseudoaneurysm of the Right Lingual Artery: An Unusual cause of Severe Hemorrhage during Tonsillectomy. EAR, NOSE & THROAT JOURNAL 2020. [DOI: 10.1177/014556139707600815] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Profuse intraoperative hemorrhage is an uncommon complication of tonsillectomy. We present a three-year-old girl who underwent a routine adenotonsillectomy during which massive bleeding occurred from a large vessel in the right tonsillar fossae. Angiography revealed an aberrant right lingual artery with a pseudoaneurysm. The right lingual artery was embolized with multiple coils and the bleeding was halted. The causes and treatment of extracranial carotid artery pseudoaneurysms are discussed.
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Affiliation(s)
- Ron B. Mitchell
- Fellow in Pediatric Otolaryngology, Otolaryngology Consultants of Memphis, LeBonheur Childrens Medical Center, Memphis, Tennessee
| | - Kevin D. Pereira
- Fellow in Pediatric Otolaryngology, Otolaryngology Consultants of Memphis, LeBonheur Childrens Medical Center, Memphis, Tennessee
| | - Rande H. Lazar
- Fellow in Pediatric Otolaryngology, Otolaryngology Consultants of Memphis, LeBonheur Childrens Medical Center, Memphis, Tennessee
| | - Tom E. Long
- Fellow in Pediatric Otolaryngology, Otolaryngology Consultants of Memphis, LeBonheur Childrens Medical Center, Memphis, Tennessee
| | - Norman F. Fournier
- Staff Otolaryngologist, Otolaryngology Consultants of Memphis, LeBonheur Childrens Medical Center, Memphis, Tennessee
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Hertz JA, Valentino J, Kwolek CJ, Endean ED. Carotid Blowout with Infection: Management with Endovascular and Open Vascular Approaches. Vasc Endovascular Surg 2016; 38:477-81. [PMID: 15490049 DOI: 10.1177/153857440403800515] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The management of patients with head and neck cancer can be complicated by massive carotid artery hemorrhage, often requiring ligation owing to the emergent conditions and scarring from previous surgery and radiation. A case of emergent endovascular management of carotid artery hemorrhage in a patient treated for pharyngeal carcinoma is described. Hemorrhage was controlled, but on follow-up the patient developed a carotid-cutaneous fistula with exposure of the coils. Further management required the use of autogenous vein to replace the involved vessels. This case demonstrates that endovascular control of carotid hemorrhage can be successful, but close follow-up is necessary to identify potential subsequent complications.
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Affiliation(s)
- Jeffrey A Hertz
- Division of Vascular Surgery, University of Kentucky School of Medicine, Lexington, KY 40536, USA
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4
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A false aneurysm. The Journal of Laryngology & Otology 2012; 126 Suppl 2:S14-5. [PMID: 22459590 DOI: 10.1017/s0022215112000370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We report a case of a remaining hemi-thyroid following laryngectomy, which was misinterpreted as a pseudoaneurysm. METHODS Case report and comment on this understandable error which is easily avoidable. RESULTS A 59-year-old man had undergone salvage laryngectomy for recurrent squamous cell carcinoma of the larynx, which had previously been treated with radiotherapy. Three months after his laryngectomy, he presented with a sore neck and subcutaneous collections. Computed tomography revealed a unilateral mass with high signal contrast uptake anterior to the left common carotid artery, which was thought initially to be a carotid pseudoaneurysm. Further investigation, including ultrasonography and a review by the senior head and neck radiologist, demonstrated that this mass was actually the remnant hemi-thyroid preserved at laryngectomy (which is often misshapen compared with a normal hemi-thyroid). The collections were found to be recurrent tumour, and unnecessary further interventions were avoided. CONCLUSION Ultrasonography easily distinguishes between a thyroid remnant and a pseudoaneurysm. Furthermore, the opinion of an experienced head and neck radiologist may be vital when interpreting complex post-surgical head and neck radiology.
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DeRubertis BG, Hynecek RL, Kent KC, Faries PL. Carotid Tortuosity in Patients With Prior Cervical Radiation. Vasc Endovascular Surg 2011; 45:619-26. [DOI: 10.1177/1538574411408745] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Anatomic distortion associated with radiation-induced tissue changes may pose challenges for patients with prior cervical irradiation undergoing carotid stenting. We sought to evaluate the effect of these changes on carotid intervention. Methods: Carotid angioplasty and stenting (CAS) for high-grade stenosis was performed in 203 patients. In all, 12 consecutive patients with prior ipsilateral cervical irradiation were age-/sex-matched to 24 controls. Degree of internal carotid (IC) tortuosity was assessed by 4 methods: ( a) deviation of IC from common carotid (CCA) axis, ( b) number of intersections between this axis and the course of the IC, ( c) total degrees of angulation along the course of the extracranial IC, and ( d) the IC length to straight-line distance ratio. Results: Carotid angioplasty and stenting was successful in all patients. Mean age was 72.8 ± 10 years; 58.4% were male. Twenty-nine percent were symptomatic (14.4% transient ischemic attack [TIA], 8.5% cardiovascular accident [CVA], and 6.5% amaurosis). Comorbidities were similar between the entire cohort and the subgroups of irradiated/control patients. The IC revealed a higher degree of deviation from the axis of the CCA in the previously irradiated patients compared to those without radiation (29.2° ± 4.5° vs 13.0° ± 2.0°, P = .001) and was more likely to intersect this axis in those with a history of cervical irradiation (83.3% vs 14.3%, P < .05). Irradiated patients also exhibited a significantly greater degree of tortuosity versus nonirradiated patients when assessed by total angulation along the course of the carotid (171.8° ± 26.0° vs 74.2° ± 20.2°, P = .014) and by the IC length:distance ratio (1.14 ± 0.05 vs 1.04 ± 0.03, P = .020). Despite increased IC tortuosity in patients with prior irradiation, all procedures were successfully completed and there did not appear to be a predilection for a specific filter type. Conclusions: A history of cervical irradiation is associated with increased tortuosity of the IC, leading to potential challenges for filter and stent deployment. However, this increased procedural complexity did not affect technical success rate or device selection in this series.
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Affiliation(s)
- Brian G. DeRubertis
- Division of Vascular Surgery, UCLA Medical Center, Geffen School of Medicine, Los Angeles, CA, USA
| | | | - K. Craig Kent
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Peter L. Faries
- Division of Vascular Surgery, Mount Sinai School of Medicine, New York, NY, USA
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Maruyama Y, Arai K, Hoshida S, Yoneda K, Furukawa M, Yoshizaki T. Case of three delayed complications of radiotherapy: Bilateral vocal cord immobility, esophageal obstruction and ruptured pseudoaneurysm of carotid artery. Auris Nasus Larynx 2009; 36:505-8. [DOI: 10.1016/j.anl.2008.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Revised: 11/14/2008] [Accepted: 11/18/2008] [Indexed: 10/21/2022]
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Zsófia M, Katalin K, Judit V, György S, Arpád I. What is the Price of survival in Hodgkin's lymphoma? Long-term follow-up of cured patients. Hematol Oncol 2007; 25:178-83. [PMID: 17607807 DOI: 10.1002/hon.824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The paper investigates the late complications of cured Hodgkin's lymphoma (HL) patients. Ninety cured HL patients between 1975 and 1994 were examined. The mean ages of patients at the time of diagnosing HL, and the median period of survival after diagnosis were 32 (11-70) years and 18 (10-30) years, respectively. Among the 90 patients, 73 are still alive, there is no information about 9 and 8 patients died, second malignant disease being the cause of death in 4 of them. Relapse was observed in 24 patients, of which 19 recovered after relapse and were included in the study then. Five patients had late relapse. In 38% of patients, cardiovascular changes, while in 32% pulmonary and pleural damages were observed. Disorders of the thyroid gland, overwhelmingly hypothyroidism, were found in 24%. Less frequently, a second malignant tumour (9%), damage to the skin, musculature, bones and genitourinary system (6%) as well as the gastrointestinal system could be detected. Treatment based on modern therapeutic approaches is expected to decrease the incidence of complications. Still the aim is early detection through close patient follow-up, which may improve the quality of life and decrease mortality as a result.
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Affiliation(s)
- Miltényi Zsófia
- 3rd Department of Internal Medicine, Institute for Internal Medicine, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary.
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Bakhos D, Lescanne E, Cottier JP, Beutter P, Morinière S. Anévrysme de l’artère carotide interne dans sa portion extracrânienne. ACTA ACUST UNITED AC 2004; 121:245-8. [PMID: 15545934 DOI: 10.1016/s0003-438x(04)95516-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Extracranial aneurysm of the internal carotid artery is an exceptional finding. CASE REPORT An 89-year-old woman consulted for a peritonsillar mass. Physical examination revealed a parapharyngeal pulsatile mass in the oropharynx. Computed tomography (CT) provided the diagnosis of extracranial internal carotid artery aneurysm. Endovascular or surgical treatment were declined. Anticoagulation medication was given. DISCUSSION We reviewed the CT and magnetic resonance imaging findings and the clinical manifestations of extracranial internal artery aneurysm. Endovascular treatment is an alternative to open surgery.
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Affiliation(s)
- D Bakhos
- Service d'ORL et de chirurgie cervico-faciale, CHU Bretonneau, 2 boulevard Tonellé 37000 Tours, France
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López-Espada C, Maldonado-Fernández N, García-Róspide V. Fístula carotidocutánea secundaria a radioterapia cervical. ANGIOLOGIA 2004. [DOI: 10.1016/s0003-3170(04)74859-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yamashita T, Higami T, Shida T. Surgical correction of pseudoaneurysm of the extracranial carotid artery: the usefulness of retrograde cerebral perfusion--a case report. Vasc Endovascular Surg 2003; 37:445-8. [PMID: 14671701 DOI: 10.1177/153857440303700610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although a pseudoaneurysm of the common carotid artery is not encountered frequently, its surgical treatment is technically challenging. A case is reported of a large pseudoaneurysm of the right common carotid artery in a 45-year-old woman, presenting with respiratory distress, following a wound infection 3 months after tracheoplasty. Instead of a vascular shunt, deep hypothermic circulatory arrest with retrograde cerebral perfusion was used for protection of the brain against hypoxia during the arterial reconstruction. The pseudoaneurysm was easily corrected with an autologous saphenous vein, without any hazardous dissection through the dense fibrosis around the fragile pseudoaneurysm, under circulatory arrest.
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Affiliation(s)
- T Yamashita
- Department of Surgery I, Shimane Medical University, Izumo, Shimane, Japan.
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Low YM, Goh YH. Endovascular treatment of epistaxis in patients irradiated for nasopharyngeal carcinoma. CLINICAL OTOLARYNGOLOGY AND ALLIED SCIENCES 2003; 28:244-7. [PMID: 12755765 DOI: 10.1046/j.1365-2273.2003.00699.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Posterior epistaxis commonly occurs after radiotherapy for nasopharyngeal carcinoma and is difficult to treat. Endovascular treatment was carried out on 11 previously irradiated patients who presented with intractable epistaxis over 4 years. We review their outcomes. All had significant angiographic abnormalities. Ten patients underwent intra-arterial embolization and, in one patient, balloon occlusion of an arterial pseudo-aneurysm was performed. Two patients (18%) suffered permanent neurological deficits. Two (18%) required further embolization in the first 2 days and one (9%) after the first month. One patient (9%) is still alive 4 years later. Only three (27%) died from haemorrhage. The mean survival duration after treatment was 225 days. Post-radiation anatomical changes often make conventional treatment of epistaxis difficult. Endovascular treatment maps out aberrant vascular anatomy and identifies the offending vessel. Our results show that the survival benefit of this treatment outweighs the risks, as such haemorrhage is often fatal.
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Affiliation(s)
- Yin Mei Low
- Department of Otolaryngology, Singapore General Hospital, Singapore.
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Ernemann U, Herrmann C, Plontke S, Schäfer J, Plasswilm L, Skalej M. Pseudoaneurysm of the superior thyroid artery following radiotherapy for hypopharyngeal cancer. Ann Otol Rhinol Laryngol 2003; 112:188-90. [PMID: 12597295 DOI: 10.1177/000348940311200215] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Carotid blowout syndrome is a devastating complication in head and neck cancer patients that is attributed to multifocal, iatrogenic arteriopathy following radical surgery or irradiation. Pseudoaneurysms of the carotid artery or its small branches are the most frequently recognized of these vascular lesions. We present a case of a ruptured pseudoaneurysm of the superior thyroid artery that was probably induced by radiation vasculopathy and was successfully treated by embolization therapy.
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Affiliation(s)
- Ulrike Ernemann
- Department of Neuroradiology, University Hospital Tübingen, Tübingen, Germany
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Shu CH, Cheng H, Lirng JF, Chang FC, Chao Y, Chi KH, Yen SH. Salvage surgery for recurrent nasopharyngeal carcinoma. Laryngoscope 2000; 110:1483-8. [PMID: 10983947 DOI: 10.1097/00005537-200009000-00014] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the efficacy of salvage surgery in the treatment of recurrent nasopharyngeal carcinoma (NPC) at the primary site. STUDY DESIGN A retrospective investigation of the outcome of salvage surgery for 28 patients with recurrent NPC after definite radiation therapy. METHODS The nasopharynx was approached anteroposteriorly by the transmaxillary approach (maxillary swing, maxillectomy) or inferior approach (midline mandibulotomy or median labiomandibular glossotomy), or laterally by modified facial translocation or transpterygoid approach; intentional ligation of the internal carotid artery was performed after establishment of extracranial-intracranial (EC-IC) bypass in one patient; postoperative irradiation was given to the patients with positive pathological margins. RESULTS Nine patients lived without disease for 20 to 93 months (mean interval, 52 mo) after surgery; among them, eight patients had T1 tumors that were resected totally by surgery via anteroposterior approaches and the other patient had postoperative irradiation to control the disease. Seven patients had local recurrence 8 to 21 months after treatment. Four patients developed distant metastases, including one patient with a T2b tumor that was totally resected through modified facial translocation approach with ligation of internal carotid artery. Eight patients died of other causes; internal carotid artery blowout was the cause of death in four of these eight patients. CONCLUSIONS In most cases of recurrence, T1 nasopharyngeal tumors can be resected totally by anteroposterior approaches; for T2 or larger tumors, postoperative irradiation is usually necessary. Otherwise, facial translocation offers a better chance to completely resect the tumors. Internal carotid artery is better ligated if patients have received greater than 70 Gy irradiation or if the artery must be exposed during the surgery. We suggest that EC-IC bypass be used to avoid the possible complications (or cerebral ischemic stroke) caused by ligation of internal carotid artery. The transmaxillary approach is favored in the management of nasopharyngeal tumor recurrence with nasal cavity extension, and midline mandibulotomy is more suitable for resection of posterior margin of nasopharyngeal tumor recurrence. Facial translocation offers the widest operative field and is the most versatile approach for radical resection of nasopharyngeal tumor recurrence, but the surgeon should be skilled in the management of the facial nerves to reduce morbidity.
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Affiliation(s)
- C H Shu
- Department of Otolaryngology, Veterans General Hospital, Taipei and National Yang-Ming University School of Medicine, Taiwan
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Ambalavanar R, Tanaka Y, Damirjian M, Ludlow C. Laryngeal afferent stimulation enhances fos immunoreactivity in periaqueductal gray in the cat. J Comp Neurol 1999. [DOI: 10.1002/(sici)1096-9861(19990705)409:3<411::aid-cne6>3.0.co;2-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Rhee CS, Jinn TH, Jung HW, Sung MW, Kim KH, Min YG. Traumatic pseudoaneurysm of the external carotid artery with parotid mass and delayed facial nerve palsy. Otolaryngol Head Neck Surg 1999; 121:158-60. [PMID: 10388901 DOI: 10.1016/s0194-5998(99)70147-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- C S Rhee
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Yongon-dong, Chongno-gu, South Korea
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