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Yu KW, Wu CH, Lin TM, Tai WA, Luo CB, Chang FC. Endovascular Management of Post-Irradiated Carotid Blowout Syndrome in Patients with Lower Neck Cancers. Eur J Vasc Endovasc Surg 2024; 67:708-716. [PMID: 38182115 DOI: 10.1016/j.ejvs.2023.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/04/2023] [Accepted: 12/30/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Lower neck cancers (LNCs) include specific tumour types and have some different vascular supply or collaterals from other head and neck cancers. This prospective study evaluated the outcome of endovascular management of post-irradiated carotid blowout syndrome (PCBS) in patients with LNC by comparing reconstructive management (RE) and deconstructive management (DE). METHODS This was a single centre, prospective cohort study. Patients with LNC complicated by PCBS between 2015 and 2021 were enrolled for RE or DE. RE was performed by stent graft placement covering the pathological lesion and preventive external carotid artery (ECA) embolisation without balloon test occlusion (BTO). DE was performed after successful BTO by permanent coil or adhesive agent embolisation of the internal carotid artery (ICA) and ECA to common carotid artery, or ICA occlusion alone if the pathological lesion was ICA only. Cross occlusion included the proximal and distal ends of the pathological lesion in all patients. Re-bleeding events, haemostatic period, and neurological complications were evaluated. RESULTS Fifty-nine patients (mean age 58.5 years; 56 male) were enrolled, including 28 patients undergoing RE and 31 patients undergoing DE. Three patients originally grouped to DE were transferred to RE owing to failed BTO. The results of RE vs. DE were as follows: rebleeding events, 13/28 (46%) vs. 10/31 (32%) (p = .27); haemostatic period, 9.4 ± 14.0 months vs. 14.2 ± 27.8 months (p = .59); neurological complication, 4/28 (14%) vs. 5/31 (16%) (p = .84); and survival time, 11.8 ± 14.6 months vs. 15.1 ± 27.5 months (p = .61). CONCLUSION No difference in rebleeding risk or neurological complications was observed between the DE and RE groups. RE could be used as a potential routine treatment for PCBS in patients with LNC.
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Affiliation(s)
- Kai-Wei Yu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Te-Ming Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-An Tai
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chao-Bao Luo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Slijepcevic AA, Roh J, Pipkorn P, Lipsey K, Bradley JP. Carotid Blowout Syndrome in Head and Neck Cancer Patients: Management of Patients At Risk for CBS. Laryngoscope 2023; 133:576-587. [PMID: 35575599 DOI: 10.1002/lary.30157] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/16/2022] [Accepted: 04/09/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Carotid blowout syndrome (CBS) is an acute, rare life-threatening hemorrhage that occurs in patients with a history of head and neck cancer and radiation therapy. The primary objective of this review was to identify risk factors and assess treatment and survival outcomes following CBS. METHODS A systematic review of published literature was performed. Information including risk factors, treatment, and outcomes of CBS were collected. RESULTS A total of 49 articles and 2220 patients were included in the systematic review. Risk factors for developing CBS included a history of radiation therapy, wound complications, and advanced tumor stage. The initial management of CBS included establishing a stable airway, gaining hemostasis, and repletion of blood loss. Endovascular and surgical procedures treat CBS with infrequent rates of rebleeding and periprocedural complications. Short-term survival following treatment of CBS shows high survival rates when considering CBS-related complications and underlying disease, however, long-term survival related to the underlying disease demonstrated high mortality. CONCLUSIONS Identifying patients at risk for CBS enables practitioners to counsel patients on life-saving interventions and expected outcomes following treatment of CBS. Treatment of CBS is associated with high short-term survival, although long-term survival related to underlying disease is low. LEVEL OF EVIDENCE N/A Laryngoscope, 133:576-587, 2023.
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Affiliation(s)
- Allison A Slijepcevic
- Department of Otolaryngology-Head & Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Joseph Roh
- Department of Otolaryngology-Head & Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head & Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kim Lipsey
- Bernard Becker Medical Library, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Joseph P Bradley
- Department of Otolaryngology-Head & Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
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Szalkowski G, Karakas Z, Cengiz M, Schreiber E, Das S, Yazici G, Ozyigit G, Mavroidis P. Stereotactic body radiotherapy optimization to reduce the risk of carotid blowout syndrome using normal tissue complication probability objectives. J Appl Clin Med Phys 2022; 23:e13563. [PMID: 35194924 PMCID: PMC9121056 DOI: 10.1002/acm2.13563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/14/2022] [Accepted: 02/02/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To determine the possibility of further improving clinical stereotactic body radiotherapy (SBRT) plans using normal tissue complication probability (NTCP) objectives in order to minimize the risk for carotid blowout syndrome (CBOS). Methods 10 patients with inoperable locally recurrent head and neck cancer, who underwent SBRT using CyberKnife were analyzed. For each patient, three treatment plans were examined: (1) cone‐based without delineation of the ipsilateral internal carotid (clinical plan used to treat the patients); (2) cone‐based with the carotid retrospectively delineated and spared; and (3) Iris‐based with carotid sparing. The dose–volume histograms of the target and primary organs at risk were calculated. The three sets of plans were compared based on dosimetric and TCP/NTCP (tumor control and normal tissue complication probabilities) metrics. For the NTCP values of carotid, the relative seriality model was used with the following parameters: D50 = 40 Gy, γ = 0.75, and s = 1.0. Results Across the 10 patient plans, the average TCP did not significantly change when the plans were re‐optimized to spare the carotid. The estimated risk of CBOS was significantly decreased in the re‐optimized plans, by 14.9% ± 7.4% for the cone‐based plans and 17.7% ± 7.1% for the iris‐based plans (p = 0.002 for both). The iris‐based plans had significant (p = 0.02) reduced CBOS risk and delivery time (20.1% ± 7.4% time reduction, p = 0.002) compared to the cone‐based plans. Conclusion A significant improvement in the quality of the clinical plans could be achieved through the delineation of the internal carotids and the use of more modern treatment delivery modalities. In this way, for the same target coverage, a significant reduction in the risk of CBOS could be achieved. The range of risk reduction varied depending on the proximity of carotid artery to the target.
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Affiliation(s)
- Gregory Szalkowski
- Department of Radiation Oncology, University of North Carolina, North Carolina, Chapel Hill, USA
| | - Zeynep Karakas
- Department of Radiation Oncology, University of North Carolina, North Carolina, Chapel Hill, USA
| | - Mustafa Cengiz
- Faculty of Medicine, Department of Radiation Oncology, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Eric Schreiber
- Department of Radiation Oncology, University of North Carolina, North Carolina, Chapel Hill, USA
| | - Shiva Das
- Department of Radiation Oncology, University of North Carolina, North Carolina, Chapel Hill, USA
| | - Gozde Yazici
- Faculty of Medicine, Department of Radiation Oncology, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Gokhan Ozyigit
- Faculty of Medicine, Department of Radiation Oncology, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Panayiotis Mavroidis
- Department of Radiation Oncology, University of North Carolina, North Carolina, Chapel Hill, USA
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4
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Predictors of survival following carotid blowout syndrome. Oral Oncol 2022; 125:105723. [DOI: 10.1016/j.oraloncology.2022.105723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/26/2021] [Accepted: 01/09/2022] [Indexed: 11/19/2022]
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Kolu M, Yıldırım İO. Treatment of a patient with carotid blowout syndrome with a new deconstructive embolization technique. Radiol Case Rep 2021; 17:310-313. [PMID: 34876956 PMCID: PMC8633831 DOI: 10.1016/j.radcr.2021.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/24/2021] [Indexed: 11/07/2022] Open
Abstract
Carotid blowout syndrome is a rare clinical conditions with a high mortality rate, especially in patients with head and neck tumors who have received radiotherapy and chemotherapy. We present our patient who had hemangioendothelioma of the neck for 5 years and therefore received radiotherapy, fistulized to the skin on the neck and active bleeding out of the fistula area. In the radiological imaging of the patient, vessel wall irregularities in the common carotid artery (CCA) and accompanying pseudoaneurysm with a diameter of 3 cm were detected, and endovascular treatment was performed. After the patient passed the balloon occlusion test, first the proximal internal carotid artery was closed with coils. Then, the balloon was inflated proximal to the CCA and a 10% diluted glue-lipiodol mixture was injected into the entire diseased CCA bed. Closure of the distal with coil and proximal with balloon prevented the risk of off-target embolization of the glue.
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Affiliation(s)
- Mehmet Kolu
- Dicle University, Faculty of Medicine, Department of Radiology, Diyarbakır, Turkey
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Zhao Z, Huang L, Chen J, Huang W, Zhang X, Ma Y, Zhu H, Liu Z. Clinical efficacy of bypass grafting in recurrent nasopharyngeal carcinoma patients with internal carotid artery invasion. Am J Otolaryngol 2021; 42:102860. [PMID: 33460978 DOI: 10.1016/j.amjoto.2020.102860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/20/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND We aimed to assess the clinical efficacy of bypass grafting in recurrent nasopharyngeal carcinoma patients with internal carotid artery invasion. METHODS A retrospective analysis was performed involving 51 patients either operated by bypass grafting (n = 22) or treated with repeated chemo-radiotherapy (n = 29). RESULTS Four patients in the bypass grafting group died 3-5 months after the operation due to epistaxis and pulmonary infection (4/22, 18.2%), and three more patients exhibited a modified Rankin Scale (mRS) ≥ 2 during the follow-up (3/22, 13.6%). In the repeated chemo-radiotherapy group, 8 patients died (8/29, 27.6%), including seven patients dying within 2-3 months due to epistaxis and pulmonary infection (7/29, 24.1%). One more patient died of epistaxis after 9 months. The difference in mortality between the two treatment groups within 3 months of treatment was statistically significant (P = 0.038). CONCLUSIONS Cerebrovascular reconstruction after detailed collateral flow assessment is an effective treatment for recurrent NPC patients with internal carotid artery invasion.
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Lin YC, Chou FI, Liao JW, Liu YH, Hwang JJ. The Effect of Low-Dose Gamma Irradiation on the Uptake of Boronophenylalanine to Enhance the Efficacy of Boron Neutron Capture Therapy in an Orthotopic Oral Cancer Model. Radiat Res 2021; 195:347-354. [PMID: 33513230 DOI: 10.1667/rade-20-00102.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 12/18/2020] [Indexed: 11/03/2022]
Abstract
The success of boron neutron capture therapy (BNCT) mainly depends on the boron concentration in the tumor and a high tumor/normal tissue (T/N) boron ratio or a high tumor/blood (T/B) boron ratio. Therefore, the effective enhancement of boron ratios is the first priority. Our study investigated whether a low-dose of γ-radiation (LDR) could improve boron ratios and enhance the therapeutic effects of BNCT in an orthotopic human oral squamous cell carcinoma-bearing animal model. SAS/luc cells were used to establish the orthotopic tumor-bearing model. The pharmacokinetics of boronophenylalanine (BPA) administration with 400 mg/kg of body weight both alone and in combination with LDR (0.1 Gy) was evaluated, and BNCT was performed at the Tsing Hua Open-pool Reactor (THOR). The radiation doses were evaluated using a treatment planning system. Moreover, tumor growth and metastasis were monitored via bioluminescence imaging (BLI). The therapeutic effects after BNCT were evaluated using BLI, histopathological findings and the overall survival rate. LDR increased the BPA accumulation in tumors by 52.2%. T/N and T/B ratios were enhanced from 3.77 to 5.31 and from 3.47 to 4.46, respectively. Radiation dose was increased by 44.3%. Notably, tumor recurrence and cervical lymph node metastasis were observed in the BNCT group, which had a survival rate of 50%. Complete responses were found in the combined-treatment group, which had a survival rate of 100%. No toxicity was found according to the histopathological findings. Conclusively, LDR increased BPA accumulation in the tumor and the T/N and T/B ratios, resulting in BNCT efficacy improvement and the overall survival rate extension.
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Affiliation(s)
- Yu-Chuan Lin
- Nuclear Science and Technology Development Center, National Tsing Hua University, Hsinchu, Taiwan
| | - Fong-In Chou
- Nuclear Science and Technology Development Center, National Tsing Hua University, Hsinchu, Taiwan
| | - Jiunn-Wang Liao
- Graduate Institute of Veterinary Pathobiology, National Chung Hsing University, Taichung, Taiwan
| | - Yuan-Hao Liu
- Department of Nuclear Science and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Jeng-Jong Hwang
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
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Feng K, Hu J, Huang Q, Cai W, Zhuang Z, Liu H, Hou J, Liu X, Wang C. Risk factors and nomogram for predicting carotid blowout syndrome based on computed tomography angiography. Oral Dis 2021; 28:2131-2138. [PMID: 33772979 DOI: 10.1111/odi.13859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/03/2021] [Accepted: 03/19/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify independent factors for head and neck cancer (HNC) patients with carotid blowout syndrome (CBS) and construct a nomogram to predict risk of CBS preoperatively based on computed tomography angiography (CTA) imaging. SUBJECT AND METHODS From January 2010 to July 2020, 73 HNC patients who had surgery in hospitalization and underwent CTA examination for head and neck region were included in this study. Vascular alterations and the relationship between carotid artery (CA) and tumor were evaluated in CTA. Clinical and CTA imaging features were distinguished by logistic regression analysis and used to perform receiver operating curve analysis. Nomogram was created to predict risk of CBS and assessed by concordance index (C-index) and calibration curve. RESULTS Three independent risk factors were identified, including radical neck dissection, CA surrounded by tumor, and CA invaded by tumor without clear boundary. Area under curve of the combination of 3 variables was 0.836 (95% CI, 0.72-0.952, p < 0.001). The C-index of nomogram was 0.84 (95% CI, 0.73-0.94), and the calibration plot showed a good fitting between prediction and observation. CONCLUSIONS We established a useful nomogram based on CTA imaging, which showed a satisfied efficacy for evaluating risk of CBS in HNC patients preoperatively.
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Affiliation(s)
- Kun Feng
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Jing Hu
- Department of Oral and Maxillofacial Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qiuyu Huang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Weixin Cai
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Zehang Zhuang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Haichao Liu
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Jinsong Hou
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Xiqiang Liu
- Department of Oral and Maxillofacial Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Cheng Wang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
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Chung CH, Roh YN, Lee SH, Jeong YS, Hong JH, Sohn SI, Park H. Endovascular treatment for pseudoaneurysm after carotid blowout syndrome. JOURNAL OF NEUROCRITICAL CARE 2020. [DOI: 10.18700/jnc.200026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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10
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Zhao Z, Huang L, Chen J, Huang W, Zhang X, Ma Y, Zhu H, Liu Z. Comprehensive Treatment Strategy for Internal Carotid Artery Blowout Syndrome Caused by Nasopharyngeal Carcinoma. Otolaryngol Head Neck Surg 2020; 164:1058-1064. [PMID: 33167757 DOI: 10.1177/0194599820963129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate a treatment strategy for internal carotid artery blowout syndrome caused by nasopharyngeal carcinoma. STUDY DESIGN A retrospective analysis of a case series was performed. SETTING Carotid blowout syndrome is a catastrophic complication caused by malignant tumor of the skull base. METHODS A retrospective analysis based on 69 patients with internal carotid artery blowout syndrome admitted to our center between April 2018 and January 2020 was performed. The patients were divided into 2 groups: an EBBA (internal carotid artery embolization + bypass based on American Society of Intervention and Therapeutic Neuroradiology/Society of Interventional Radiology [ASITN/SIR]) group and an embolization/stent group. The follow-up time was 6 to 9 months. RESULTS In the EBBA group, 41 patients (41/49, 83.7%) survived. Forty patients had a satisfactory quality of life after 3 months. No death occurred within 3 months. Nonoperative death occurred in 8 cases (8/49, 16.3%). The rate of mortality and disability was 18.4% (9/49). In the embolization/stent group, 16 patients (16/20, 80%) survived. Nonoperative death occurred in 4 cases (4/20, 20%), 3 of which occurred within 1 to 3 months. Four cases reported Modified Rankin Scale ≥2 after 3 months. The rate of mortality and disability was 40% (8/20). CONCLUSION A comprehensive revascularization strategy for internal carotid artery (ICA) embolization and intracranial and extracranial bypass grafting based on ASITN/SIR score for ICA blowout syndrome patients not only can prolong the patient survival but also greatly improve the survival probability and quality of life as well as reduce their rate of mortality or disability.
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Affiliation(s)
- Zhouyang Zhao
- Department of Neurosurgery, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Lijin Huang
- Department of Neurosurgery, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Jinhua Chen
- Department of Neurosurgery, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Weijia Huang
- Department of Neurosurgery, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Xiaobin Zhang
- Department of Neurosurgery, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Yue Ma
- Department of Neurosurgery, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Hongshen Zhu
- Department of Neurosurgery, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Zhang Liu
- Department of Neurosurgery, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
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Harada T, Fujita A, Sakata J, Kohta M, Kohmura E. Endovascular Internal Trapping by Low-Concentration N-butyl-2-Cyanoacrylate for a Ruptured Giant Common Carotid Artery Pseudoaneurysm. Vasc Endovascular Surg 2020; 55:81-85. [PMID: 32873222 DOI: 10.1177/1538574420953942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Treating carotid blowout syndrome following rupture of giant pseudoaneurysms is difficult because the destroyed parent artery precludes conventional treatment. We present a patient with a ruptured giant pseudoaneurysm that we occluded using a modified internal trapping technique with low-concentration N-butyl-2-cyanoacrylate (NBCA) and a minimum number of coils. An 80-year-old man with a history of chemoradiation therapy for oropharyngeal cancer presented with several episodes of active bleeding from the subsequent tracheostomy site. Radiological examination revealed a giant right common carotid artery (CCA) pseudoaneurysm. Endovascular internal trapping was performed using both NBCA and coils under proximal flow control. We slowly injected 9 ml of low-concentration NBCA, which subsequently filled the entire pseudoaneurysm. We then injected an additional 2 ml of NBCA into the proximal CCA to achieve complete obliteration. No re-bleeding was observed during the 6-month follow-up. Endovascular internal trapping using low-concentration NBCA was feasible to treat a giant CCA pseudoaneurysm. The injected low-concentration NBCA filled the entire pseudoaneurysm without the risk of catheter entrapment.
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Affiliation(s)
- Tomoaki Harada
- Department of Neurosurgery, 38303Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi Fujita
- Department of Neurosurgery, 38303Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junichi Sakata
- Department of Neurosurgery, 38303Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaaki Kohta
- Department of Neurosurgery, 38303Kobe University Graduate School of Medicine, Kobe, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, 38303Kobe University Graduate School of Medicine, Kobe, Japan
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12
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Kamran M, Wallace AN, Adewumi A. Interventional Management of Head and Neck Tumors. Semin Intervent Radiol 2020; 37:157-165. [PMID: 32419728 DOI: 10.1055/s-0040-1709157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Advancements in medical imaging and device technology allow minimal invasive procedures for the diagnosis and treatment of various disorders. For the management of tumors in head and neck region, these image-guided interventions play essential role in the often used multidisciplinary approach. Tissue sampling under ultrasound or computed tomography guidance is generally the first step to reach a pathological diagnosis. For head and neck tumors with high vascularity, embolization using particulate matter, liquid embolic agents, or coils is used to achieve successful tumor resection with minimal blood loss. Hemorrhage related to head and neck tumors can be evaluated and managed with endovascular techniques with minimal morbidity and mortality. Intra-arterial chemotherapy, radiofrequency ablation, and cryotherapy are new techniques for the management of advanced head and neck cancer which may serve as an alternative to achieve locoregional control and survival when curative resection may not be feasible.
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Affiliation(s)
- Mudassar Kamran
- Department of Radiology, UAMS College of Medicine, Little Rock, Arkansas
| | - Adam N Wallace
- Department of Neurointerventional Surgery, Ascension Columbia St. Mary's Hospital, Milwaukee, Wisconsin
| | - Amole Adewumi
- Department of Radiology, UAMS College of Medicine, Little Rock, Arkansas
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13
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Sallustro M, Abualhin M, Faggioli G, Pilato A, Dall'Olio D, Simonetti L, Astarita F, Amorosa L, Gargiulo M. Multistep and Multidisciplinary Management for Post-irradiated Carotid Blowout Syndrome in a Young Patient With Oropharyngeal Carcinoma: A Case Report. Ann Vasc Surg 2020; 67:565.e1-565.e5. [PMID: 32209410 DOI: 10.1016/j.avsg.2020.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/08/2020] [Accepted: 02/16/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Carotid blowout syndrome is a severe complication of head and neck cancer, associated with high mortality and morbidity. METHODS We present a case of acute hemorrhage from the carotid artery of a 59-year-old man with a history of chemoradiotherapy for lingual base and oropharyngeal squamous cell carcinoma. The case was managed by a staged multidisciplinary approach of open arterial reconstruction, after initial endovascular hemorrhage control using stent graft. RESULTS The patient was discharged to home with patent carotid artery, no sign of infection or bleeding, and autonomous ambulation. A CT/PET scan performed 6 months later confirmed healing and absence of tumor recurrence. CONCLUSIONS A multidisciplinary approach involving vascular surgeons, ENT surgeons, plastic and maxillofacial surgeons is particularly appropriate in the management of carotid blowout syndrome to warrant a durable and effective repair of all the anatomical structures involved.
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Affiliation(s)
- Marianna Sallustro
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Policlinico Sant'Orsola- Malpighi, Bologna, Italy.
| | - Mohammad Abualhin
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Policlinico Sant'Orsola- Malpighi, Bologna, Italy
| | - GianLuca Faggioli
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Policlinico Sant'Orsola- Malpighi, Bologna, Italy
| | - Alessandro Pilato
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Policlinico Sant'Orsola- Malpighi, Bologna, Italy
| | - Danilo Dall'Olio
- Department of Otorhinolaryngology, Maggiore Hospital, Azienda AUSL, Bologna, Italy
| | - Luigi Simonetti
- Interventional and Urgency Radiology and Neuroradiology Unit, Maggiore Hospital, Bologna, Italy
| | - Fabio Astarita
- Department of Otorhinolaryngology, Maggiore Hospital, Azienda AUSL, Bologna, Italy
| | - Luca Amorosa
- Department of Maxillofacial Surgery, Maggiore Hospital, Azienda AUSL, Bologna, Italy
| | - Mauro Gargiulo
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Policlinico Sant'Orsola- Malpighi, Bologna, Italy
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Kligerman MP, Saraswathula A, Sethi RK, Divi V. Tracheostomy Complications in the Emergency Department: A National Analysis of 38,271 Cases. ORL J Otorhinolaryngol Relat Spec 2020; 82:106-114. [PMID: 32036376 DOI: 10.1159/000505130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/28/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Greater than 100,000 tracheotomies are performed annually in the USA, yet little is known regarding patients who present to the emergency department (ED) with tracheostomy complications. OBJECTIVES To characterize patient and hospital characteristics, outcomes, and charges associated with tracheostomy complications and to identify predictors of admission and mortality. METHODS The 2009-2011 Nationwide Emergency Department Sample (NEDS) was queried for patients with a principle diagnosis of tracheostomy complication. A descriptive analysis was performed and multivariable logistic regression was used to identify predictors of admission and mortality. RESULTS A total of 69,371 nationwide visits to the ED had tracheostomy complication as an associated ICD-9 diagnosis, of which 55.2% (n = 38,293) carried a primary diagnosis of tracheostomy complication. Unspecified tracheostomy complications were most common (61.4%), followed by mechanical complications (31.3%), and lastly by tracheostomy infections (7.3%). Pediatric patients were significantly more likely to have tracheostomy infections than adults (p < 0.0001). A total of 35.5% of patients with tracheostomy complications were admitted to the hospital, and death occurred with 1.4% of visits. Patients from higher-income ZIP codes had increased odds of admission (adjusted odds ratio [OR]: 1.35; p = 0.0009), as did patients with tracheostomy infections (OR: 4.425; p < 0.0001). Patients with tracheostomy infections (OR: 3.14; p = 0.0062) and unspecified tracheostomy complications (OR: 2.00; p = 0.0076) had increased odds of mortality. CONCLUSION These findings may help improve overall outcomes amongst patients with tracheostomies by preventing unnecessary ED admissions and improving healthcare provider preparedness and awareness.
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Affiliation(s)
- Maxwell P Kligerman
- Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California, USA,
| | - Anirudh Saraswathula
- Department of Otolaryngology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rosh K Sethi
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Vasu Divi
- Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California, USA
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15
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Matsumoto F, Matsumura S, Mori T, Mori A, Omura G, Matsumoto Y, Fukasawa M, Kobayashi K, Yoshimoto S. Common carotid artery ligation at the proximal side before rupture in patients with ligation or occlusion of the external carotid artery at risk of carotid blowout syndrome. Jpn J Clin Oncol 2019; 49:839-844. [PMID: 31135919 DOI: 10.1093/jjco/hyz075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/26/2019] [Accepted: 05/11/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Carotid blowout syndrome (CBS) is among the fatal complications in head and neck cancer treatment. However, the optimal treatment for CBS has not been established yet. This study aimed to describe our experience with two patients at high risk of CBS who underwent common carotid artery (CCA) ligation at the proximal side of the bleeding point under local anesthesia and before CCA rupture, and to review and compare the medical records of these two patients against 10 CBS cases treated in our department. METHODS The institutional electronic medical record was searched, and clinical information was extracted for all patients who showed CBS from 2007 to 2017. Our treatment method was performed as follows. Ligation of the proximal side of the CCA was performed under local anesthesia. The CCA was identified and clamped with two bulldog forceps for 10 minutes to check for any adverse neurological symptoms. Subsequently, the CCA was ligated using 2-0 silk threads and sutured with an absorbable suture between the silk threads. However, ligation or occlusion of the external carotid artery by previous treatment is a prerequisite for this method. RESULTS Eight patients received interventions, with six patients undergoing prophylactic interventions before rupture. Four patients who did not undergo treatment died owing to CBS. Two patients who underwent treatment with the novel method did not experience re-bleeding, but their conditions deteriorated owing to cancer progression. CONCLUSION The present method is one of the treatment choices for CBS, especially in patients with an 'impending' risk of CBS.
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Affiliation(s)
- Fumihiko Matsumoto
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Satoko Matsumura
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Taisuke Mori
- Department of Pathology and Clinical Laboratory, National Cancer Center Hospital, Tokyo, Japan
| | - Ayaka Mori
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Go Omura
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshifumi Matsumoto
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masahiko Fukasawa
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kenya Kobayashi
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
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16
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Jacobi C, Gahleitner C, Bier H, Knopf A. Chemoradiation and local recurrence of head and neck squamous cell carcinoma and the risk of carotid artery blowout. Head Neck 2019; 41:3073-3079. [DOI: 10.1002/hed.25796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 12/24/2022] Open
Affiliation(s)
- Christian Jacobi
- Department of Otorhinolaryngology/Head and Neck SurgeryKlinikum rechts der s Isar Technische Universität München München Germany
| | - Constanze Gahleitner
- Department of Otorhinolaryngology/Head and Neck SurgeryKlinikum rechts der s Isar Technische Universität München München Germany
| | - Henning Bier
- Department of Otorhinolaryngology/Head and Neck SurgeryKlinikum rechts der s Isar Technische Universität München München Germany
| | - Andreas Knopf
- Department of Otorhinolaryngology/Head and Neck SurgeryKlinikum rechts der s Isar Technische Universität München München Germany
- Department of Otorhinolaryngology/Head and Neck SurgeryUniversitätsklinikum Freiburg Freiburg Germany
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17
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Carotid Blowout Syndrome. Neuroradiology 2019. [DOI: 10.1016/b978-0-323-44549-8.00049-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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18
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Suárez C, Fernández-Alvarez V, Hamoir M, Mendenhall WM, Strojan P, Quer M, Silver CE, Rodrigo JP, Rinaldo A, Ferlito A. Carotid blowout syndrome: modern trends in management. Cancer Manag Res 2018; 10:5617-5628. [PMID: 30519108 PMCID: PMC6239123 DOI: 10.2147/cmar.s180164] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Carotid blowout syndrome (CBS) refers to rupture of the carotid artery and is an uncommon complication of head and neck cancer that can be rapidly fatal without prompt diagnosis and intervention. CBS develops when a damaged arterial wall cannot sustain its integrity against the patient’s blood pressure, mainly in patients who have undergone surgical procedures and radiotherapy due to cancer of the head and neck, or have been reirradiated for a recurrent or second primary tumor in the neck. Among patients irradiated prior to surgery, CBS is usually a result of wound breakdown, pharyngocutaneous fistula and infection. This complication has often been fatal in the past, but at the present time, early diagnosis and modern technology applied to its management have decreased morbidity and mortality rates. In addition to analysis of the causes and consequences of CBS, the purpose of this paper is to critically review methods for early diagnosis of this complication and establish individualized treatment based on endovascular procedures for each patient.
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Affiliation(s)
- Carlos Suárez
- Head & Neck Cancer Laboratory, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain, .,Head & Neck Cancer Laboratory, Instituto Universitario de Oncología del Principado de Asturias, CIBERONC, University of Oviedo, Oviedo, Spain,
| | | | - Marc Hamoir
- Department of Head and Neck Surgery, Head and Neck Oncology Program, King Albert II Cancer Institute, St Luc University Hospital, Brussels, Belgium
| | | | - Primoz Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Miquel Quer
- Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Carl E Silver
- Department of Surgery, University of Arizona, Phoenix, AZ, USA
| | - Juan P Rodrigo
- Head & Neck Cancer Laboratory, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain, .,Head & Neck Cancer Laboratory, Instituto Universitario de Oncología del Principado de Asturias, CIBERONC, University of Oviedo, Oviedo, Spain, .,Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group Padua, Italy
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19
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Fitting NTCP models to SBRT dose and carotid blowout syndrome data. Med Phys 2018; 45:4754-4762. [DOI: 10.1002/mp.13121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 06/01/2018] [Accepted: 07/27/2018] [Indexed: 12/29/2022] Open
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20
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Kim JY, Shin IW, Kim S, Kang SB, Lee SH, Park KE, Lee HK, Sohn JT, Chung YK. Iatrogenic common carotid artery rupture during neck surgery rescued using covered stent - A case report -. Anesth Pain Med (Seoul) 2018. [DOI: 10.17085/apm.2018.13.3.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ji Yoon Kim
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Il Woo Shin
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Anesthesiology and Pain Medicine, Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Sunmin Kim
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Se-bin Kang
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Soo-hee Lee
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kyeong Eon Park
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Heon Keun Lee
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ju-Tae Sohn
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Anesthesiology and Pain Medicine, Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Young Kyun Chung
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
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21
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Choi HC, Park SE, Choi DS, Shin HS, Kim JE, Choi HY, Park MJ, Koh EH. Ruptured extracranial carotid artery: Endovascular treatment with covered stent graft. J Neuroradiol 2018; 45:217-223. [DOI: 10.1016/j.neurad.2018.01.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 12/22/2017] [Accepted: 01/14/2018] [Indexed: 10/18/2022]
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22
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Wilseck Z, Savastano L, Chaudhary N, Pandey AS, Griauzde J, Sankaran S, Wilkinson D, Gemmete JJ. Delayed extrusion of embolic coils into the airway after embolization of an external carotid artery pseudoaneurysm. J Neurointerv Surg 2018; 10:e18. [PMID: 29627795 DOI: 10.1136/neurintsurg-2017-013178.rep] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 11/04/2022]
Abstract
Carotid blowout syndrome (CBS) is a known devastating complication of head and neck surgery. The risk of developing CBS increases in the setting of radiation therapy, wound breakdown, or tumor recurrence. Traditionally, the treatment of choice for CBS is surgical ligation of the bleeding artery; however, recently, endovascular occlusion has become a more common option. If a pseudoaneurysm is present, treatment consists of trapping with endovascular coils or occlusion with a liquid embolic agent. Delayed migration of embolization coils into the airway causing acute respiratory distress is a rare occurrence. This report presents a case of a 57-year-old woman who presented to her otolaryngologist after experiencing an episode of acute respiratory distress which resolved when she expectorated embolization coil material from her tracheostomy tube. Three months prior to the episode she underwent coil embolization of an external carotid artery pseudoaneurysm for life-threatening hemorrhage.
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Affiliation(s)
- Zachary Wilseck
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Luis Savastano
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Neeraj Chaudhary
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA.,Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Aditya S Pandey
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA.,Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Julius Griauzde
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Sumanna Sankaran
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - David Wilkinson
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Joseph J Gemmete
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA.,Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
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23
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Successful Use of Covered Stent for Carotid Artery Injury with Active Medial Projecting Extravasation. World Neurosurg 2018; 112:53-56. [DOI: 10.1016/j.wneu.2018.01.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 12/13/2022]
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24
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Wilseck Z, Savastano L, Chaudhary N, Pandey AS, Griauzde J, Sankaran S, Wilkinson DA, Gemmete JJ. Delayed extrusion of embolic coils into the airway after embolization of an external carotid artery pseudoaneurysm. BMJ Case Rep 2017; 2017:bcr-2017-013178. [PMID: 28851683 DOI: 10.1136/bcr-2017-013178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Carotid blowout syndrome (CBS) is a known devastating complication of head and neck surgery. The risk of developing CBS increases in the setting of radiation therapy, wound breakdown, or tumor recurrence. Traditionally, the treatment of choice for CBS is surgical ligation of the bleeding artery; however, recently, endovascular occlusion has become a more common option. If a pseudoaneurysm is present, treatment consists of trapping with endovascular coils or occlusion with a liquid embolic agent. Delayed migration of embolization coils into the airway causing acute respiratory distress is a rare occurrence. This report presents a case of a 57-year-old woman who presented to her otolaryngologist after experiencing an episode of acute respiratory distress which resolved when she expectorated embolization coil material from her tracheostomy tube. Three months prior to the episode she underwent coil embolization of an external carotid artery pseudoaneurysm for life-threatening hemorrhage.
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Affiliation(s)
- Zachary Wilseck
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Luis Savastano
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Neeraj Chaudhary
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA.,Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Aditya S Pandey
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA.,Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Julius Griauzde
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Sumanna Sankaran
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - D Andrew Wilkinson
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Joseph J Gemmete
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA.,Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
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25
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Prasad KK, Sirsath NT, Naiknaware KV, Rani KS, Bhatia MS. Carotid blowout syndrome: An oncological emergency less discussed. South Asian J Cancer 2017; 6:85-86. [PMID: 28702416 PMCID: PMC5506819 DOI: 10.4103/sajc.sajc_211_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Karthik K Prasad
- Department of Surgical Oncology, M N Budhrani Cancer Institute, Pune, Maharashtra, India
| | - Nagesh T Sirsath
- Department of Medical Oncology, M N Budhrani Cancer Institute, Pune, Maharashtra, India
| | - Kiran V Naiknaware
- Department of Interventional Radiology, M N Budhrani Cancer Institute, Pune, Maharashtra, India
| | - K Sandhya Rani
- Department of Radiation Oncology, M N Budhrani Cancer Institute, Pune, Maharashtra, India
| | - Manish S Bhatia
- Department of Surgical Oncology, M N Budhrani Cancer Institute, Pune, Maharashtra, India
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26
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Loja MN, Abbot C, Isaacs R, Brawley J, Humphries M. Staged Definitive Repair after Carotid Blowout: A Case Report. Ann Vasc Surg 2017; 45:263.e5-263.e9. [PMID: 28666819 DOI: 10.1016/j.avsg.2017.06.031] [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] [Received: 09/23/2016] [Accepted: 06/12/2017] [Indexed: 11/20/2022]
Abstract
Carotid blowout syndrome is a highly morbid complication of head and neck cancer. We present the case of a 51-year-old woman with common carotid artery blowout, initially temporized with an endovascular stent graft and ultimately reconstructed using autologous superficial femoral artery. The patient recovered without sequelae and continues to be asymptomatic at 1 year. We present the modern hybrid management of this complex case.
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Affiliation(s)
- Melissa N Loja
- Division of Vascular Surgery, Department of Surgery, University of California, Davis, Sacramento, CA.
| | - Christopher Abbot
- Division of Vascular Surgery, Department of Surgery, Kaiser Permanente Medical Group, Sacramento, CA
| | - Richard Isaacs
- Department of Head and Neck Surgery, Kaiser Permanente Medical Group, Sacramento, CA
| | - John Brawley
- Division of Vascular Surgery, Department of Surgery, Kaiser Permanente Medical Group, Sacramento, CA
| | - Misty Humphries
- Division of Vascular Surgery, Department of Surgery, University of California, Davis, Sacramento, CA
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27
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Bond KM, Brinjikji W, Murad MH, Cloft HJ, Lanzino G. Endovascular treatment of carotid blowout syndrome. J Vasc Surg 2017; 65:883-888. [PMID: 28236928 DOI: 10.1016/j.jvs.2016.11.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/10/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Carotid blowout syndrome (CBS) is a life-threatening complication of head and neck cancer and radiation therapy. Endovascular techniques have emerged as preferable alternatives to surgical ligation for treatment of CBS. We performed a systematic review and meta-analysis to study periprocedural complications and outcomes of CBS patients treated with coil embolization and covered stents. METHODS A comprehensive literature search identified studies that reported outcomes of endovascular treatment of CBS published from 2000 to April 2016. Outcomes included technical success, postoperative rebleeding, survival time, and perioperative complications. Meta-analyses were performed using a random-effects model. RESULTS Twenty-five noncomparative studies with 559 patients were included in the meta-analysis. Technical success rate was 100% in both coiling and covered stenting groups. Median survival time was 3 months (range, 0-96 months) for all CBS patients. Overall perioperative mortality was 11% (95% confidence interval [CI], 5%-17%). Postoperative rebleeding rate was 27% (95% CI, 19%-367%). Perioperative stroke and infection rates were 3% (95% CI, 1%-6%) and 1% (95% CI, 0%-5%), respectively. At last follow-up, 39% of patients were alive (95% CI, 29%-48%). CONCLUSIONS Coil embolization and stent grafts may both be safe treatment options for CBS with few perioperative complications and high rates of technical success, but prognosis after treatment remains poor. In general, noncomparative studies do not demonstrate differences between the two techniques with respect to periprocedural complications and patient outcomes.
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Affiliation(s)
| | | | - Mohammed H Murad
- Department of Science of Healthcare Delivery, Mayo Clinic, Rochester, Minn
| | - Harry J Cloft
- Department of Radiology, Mayo Clinic, Rochester, Minn
| | - Giuseppe Lanzino
- Department of Radiology, Mayo Clinic, Rochester, Minn; Department of Neurosurgery, Mayo Clinic, Rochester, Minn
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28
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Gleysteen J, Clayburgh D, Cohen J. Management of Carotid Blowout from Radiation Necrosis. Otolaryngol Clin North Am 2017; 49:829-39. [PMID: 27267029 DOI: 10.1016/j.otc.2016.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although the incidence of carotid blowout has decreased with the advent of better reconstructive techniques, it remains a real risk after major head and neck surgery, especially in an irradiated field. A systematic, multidisciplinary approach incorporating appropriate history and physical examination, adequate resuscitation, diagnostic computed tomography, and diagnostic and therapeutic angiography can manage most of these patients in a safe and effective manner. Surgery has a limited role in acute management, although surgical techniques are useful both for prevention of this problem and for wound management after carotid blowout.
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Affiliation(s)
- John Gleysteen
- Department of Otolaryngology/Head and Neck Surgery, Portland VA Medical Center, Oregon Health Sciences University, Portland, OR, USA
| | - Daniel Clayburgh
- Department of Otolaryngology/Head and Neck Surgery, Portland VA Medical Center, Oregon Health Sciences University, Portland, OR, USA
| | - James Cohen
- ENT, Department of Otolaryngology/Head and Neck Surgery, Portland VA Medical Center, Oregon Health Sciences University, P3-OC, 3710 Southwest US Veteran's Hospital Road, Portland, OR 97239, USA.
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29
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Chiesa Estomba CM, Betances Reinoso FA, Osorio Velasquez A, Castro Macia O, Gonzalez Cortés MJ, Araujo Nores J. Carotid blowout syndrome in patients treated by larynx cancer. Braz J Otorhinolaryngol 2016; 83:653-658. [PMID: 27789194 PMCID: PMC9449226 DOI: 10.1016/j.bjorl.2016.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/17/2016] [Accepted: 08/26/2016] [Indexed: 12/18/2022] Open
Abstract
Introduction Carotid blowout syndrome is an uncommon complication for patient treated by head and neck tumors, and related to a high mortality rate. Objective The aim of this study was to study the risk of carotid blowout in a large cohort of patients treated only by larynx cancer. Methods Retrospective analysis of patients older than 18 years, treated by larynx cancer who developed a carotid blowout syndrome in a tertiary academic centre. Results 197 patients met the inclusion criteria, 192 (98.4%) were male and 5 (1.6%) were female. 6 (3%) patients developed a carotid blowout syndrome, 4 patients had a carotid blowout syndrome located in the internal carotid artery and 2 in the common carotid artery. According to the type of rupture, 3 patients suffer a type I, 2 patients a type III and 1 patient a type II. Five of those patients had previously undergone radiotherapy and all patients underwent total laryngectomy. We found a statistical correlation between open surgical procedures (p = 0.004) and radiotherapy (p = 0.023) and the development of a carotid blowout syndrome. Conclusion Carotid blowout syndrome is an uncommon complication in patients treated by larynx tumours. According to our results, patient underwent radiotherapy and patients treated with open surgical procedures with pharyngeal opening have a major risk to develop this kind of complication.
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Affiliation(s)
| | | | | | - Olalla Castro Macia
- University Hospital of Vigo, Otorhinolaryngology, Head and Neck Surgery Department, Pontevedra, Spain
| | | | - Jesus Araujo Nores
- University Hospital of Vigo, Otorhinolaryngology, Head and Neck Surgery Department, Pontevedra, Spain
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30
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Klein Nulent CGA, de Graaff HJD, Ketelaars R, Sewnaik A, Maissan IM. Anesthetic Management During Emergency Surgical Ligation for Carotid Blowout Syndrome. ACTA ACUST UNITED AC 2016; 7:85-8. [PMID: 27310900 DOI: 10.1213/xaa.0000000000000352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 44-year-old man presented to our emergency department with a pharyngeal hemorrhage, 6 weeks after a total laryngectomy and extensive neck dissection. Immediate surgical intervention was necessary to stop massive arterial hemorrhage from the pharynx. The head and neck surgeon successfully ligated the common carotid artery during this procedure. We describe the anesthetic strategy and the thromboelastometry (ROTEM®)-guided massive transfusion protocol.
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Affiliation(s)
- Casper G A Klein Nulent
- From the *Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands; †Department of Anesthesiology, Radboud University Medical Center, Nijmegen, the Netherlands; and ‡Department of Otolaryngology Head and Neck Surgery, Erasmus Medical Center Rotterdam, the Netherlands
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Chang FC, Luo CB, Lirng JF, Lin CJ, Lee HJ, Wu CC, Hung SC, Guo WY. Endovascular Management of Post-Irradiated Carotid Blowout Syndrome. PLoS One 2015; 10:e0139821. [PMID: 26439632 PMCID: PMC4595276 DOI: 10.1371/journal.pone.0139821] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 09/17/2015] [Indexed: 12/28/2022] Open
Abstract
Purpose To retrospectively evaluate the clinical and technical factors related to the outcomes of endovascular management in patients with head-and-neck cancers associated with post-irradiated carotid blowout syndrome (PCBS). Materials and Methods Between 2000 and 2013, 96 patients with PCBS underwent endovascular management. The 40 patients with the pathological lesions located in the external carotid artery were classified as group 1 and were treated with embolization. The other 56 patients with the pathological lesions located in the trunk of the carotid artery were divided into 2 groups as follows: group 2A comprised the 38 patients treated with embolization, and group 2B comprised the 18 patients treated with stent-graft placement. Fisher’s exact test was used to examine endovascular methods, clinical severities, and postprocedural clinical diseases as predictors of outcomes. Results Technical success and immediate hemostasis were achieved in all patients. The results according to endovascular methods (group 1 vs 2A vs 2B) were as follows: technical complication (1/40[2.5%] vs 9/38[23.7%] vs 9/18[50.0%], P = 0.0001); rebleeding (14/40[35.0%] vs 5/38[13.2%] vs 7/18[38.9%]), P = 0.0435). The results according to clinical severity (acute vs ongoing PCBS) were as follows: technical complication (15/47[31.9%] vs 4/49[8.2%], P = 0.0035); rebleeding (18/47[38.3%] vs 8/49[16.3%], P = 0.0155). The results according to post-procedural clinical disease (regressive vs progressive change) were as follows: alive (14/21[66.7%] vs 8/75[10.7%], P<0.0001); survival time (34.1±30.6[0.3–110] vs 3.6±4.0[0.07–22] months, P<0.0001). Conclusion The outcomes of endovascular management of PCBS can be improved by taking embolization as a prior way of treatment, performing endovascular intervention in slight clinical severity and aggressive management of the post-procedural clinical disease.
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Affiliation(s)
- Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang Ming University, School of Medicine, Taipei, Taiwan
- * E-mail:
| | - Chao-Bao Luo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Jiing-Feng Lirng
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Chung-Jung Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Han-Jui Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Chih-Chun Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Sheng-Che Hung
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Wan-Yuo Guo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang Ming University, School of Medicine, Taipei, Taiwan
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Fujita T, Ito K, Tanabe M, Matsunaga N. Prophylactic placement of a covered nitinol stent to prevent carotid blowout in a patient with supraclavicular lymph node metastasis from esophageal cancer. SPRINGERPLUS 2015; 4:448. [PMID: 26322254 PMCID: PMC4547978 DOI: 10.1186/s40064-015-1243-9] [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: 06/15/2015] [Accepted: 08/13/2015] [Indexed: 11/26/2022]
Abstract
Enlargement of primary tumor and metastatic lymph nodes in patients with head and neck cancer can be progressive and invade the surrounding vessels despite intensive treatment. Carotid blowout (CBS) tends to occur in these patients, and prompt treatment is required. Surgical management of carotid blowout is technically troublesome because exploration and repair of the previously irradiated or tumor-invaded field are difficult. Endovascular therapy with stent deployment is a good alternative to surgery. Even with such interventional procedures as stent grafting, it is sometimes difficult to obtain favorable outcomes in end-stage patients with poor general conditions. The prophylactic placement of a covered nitinol stent was performed to prevent carotid blowout in a patient with supraclavicular lymph node metastasis from esophageal cancer, and fatal bleeding due to carotid blowout was avoided. The usefulness of the prophylactic placement of a covered nitinol stent for preventing carotid blowout in an end-stage patient is presented.
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Affiliation(s)
- Takeshi Fujita
- Department of Radiology, Ube Industries, Ltd. Central Hospital, 750 Nishikiwa, Ube, Yamaguchi 755-0151 Japan
| | - Katsuyoshi Ito
- Department of Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192 Japan
| | - Masahiro Tanabe
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 Japan
| | - Naofumi Matsunaga
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 Japan
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Farivar BS, Lee DH, Khalil A, Abrol S, Flores L. Carotid Blowout Syndrome: Endovascular Management of Acute Hemorrhage with Tapering Overlapped Covered Stents. Ann Vasc Surg 2014; 28:1934.e7-1934.e11. [DOI: 10.1016/j.avsg.2014.06.075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 05/01/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
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Dequanter D, Shahla M, Paulus P, Aubert C, Lothaire P. Transarterial endovascular treatment in the management of life-threatening carotid blowout syndrome in head and neck cancer patients: review of the literature. ACTA ACUST UNITED AC 2013; 38:341-4. [PMID: 24210746 DOI: 10.1016/j.jmv.2013.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 09/25/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Carotid blowout syndrome is a rare but devastating complication in patients with head and neck malignancy, and is associated with high morbidity and mortality. Bleeding from the carotid artery or its branches is a well-recognized complication following treatment or recurrence of head and neck cancer. It is an emergency situation, and the classical approach to save the patient's life is to ligate the carotid artery. But the surgical treatment is often technically difficult. Endovascular therapies were recently reported as good alternatives to surgical ligation. METHODS Retrospective review of three cases of acute or threatened carotid hemorrhage managed by endovascular therapies. RESULTS Two patients presented with acute carotid blowout, and one patient with a sentinel bleed. Two patients had previously been treated with surgery and chemo radiation. One patient was treated by chemo radiation. Two had developed pharyngocutaneous fistulas, and one had an open necrosis filled wound that surrounded the carotid artery. In two patients, stent placement resolved the acute hemorrhage. In one patient, superselective embolization was done. Mean duration follow-up was 10.2 months. No patient had residual sequelae of stenting or embolization. CONCLUSION Management of carotid blow syndrome is very critical and difficult. A multidisciplinary approach is very important in the management of carotid blow syndrome. Correct and suitable management can be life saving. An endovascular technique is a good and effective alternative with much lower morbidity rates than surgical repair or ligation.
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Affiliation(s)
- D Dequanter
- Head and Neck Department, 706, rue de Gozée, 6110 Montigny-le-Tilleul, Belgium.
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35
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Chang FC, Luo CB, Lirng JF, Lin CJ, Wu HM, Hung SC, Guo WY, Teng M, Chang CY. Evaluation of the outcomes of endovascular management for patients with head and neck cancers and associated carotid blowout syndrome of the external carotid artery. Clin Radiol 2013; 68:e561-9. [PMID: 23835404 DOI: 10.1016/j.crad.2013.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 02/18/2013] [Accepted: 02/27/2013] [Indexed: 10/26/2022]
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Abstract
Clinically significant bleeding occurs in approximately 6%-10% of patients in the palliative-care setting. Bleeding can range from persistent and small in quantity (but enough to interfere with a patient's quality of life), to catastrophic bleeding that ultimately leads to the rapid demise of the patient. Uncontrolled bleeding can be very distressing for staff, patients and families. Advanced planning is necessary in all bleeding circumstances. This session will review the types of cancer associated with bleeding, as well as management options for these situations. Emphasis will be placed on aspects of communication with families.
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Affiliation(s)
- Eric Prommer
- UCLA School of Medicine, Division of Hematology /Oncology, VIP Palliative Care Program, Greater Los Angeles Healthcare, 11301 Wilshire 111-H, Los Angeles, CA, USA.
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Lee CW, Yang CY, Chen YF, Huang A, Wang YH, Liu HM. CT angiography findings in carotid blowout syndrome and its role as a predictor of 1-year survival. AJNR Am J Neuroradiol 2013; 35:562-7. [PMID: 23969344 DOI: 10.3174/ajnr.a3716] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Carotid blowout is a serious late complication of prior treatment of advanced head and neck cancer. We evaluate the efficacy of CTA in the diagnosis of impending carotid blowout syndrome in patients with head and neck cancer, and its capability to predict clinical outcome. MATERIALS AND METHODS The clinical data of 29 patients with impending carotid blowout who underwent CTA were collected and analyzed. Imaging signs included tissue necrosis, exposed artery, viable perivascular tumor, pseudoaneurysm, and contrast extravasation. DSA was obtained in 20 patients. One-year outcomes were compared based on management. RESULTS The most common CTA finding was necrosis (94%), followed by exposed artery (73%), viable tumor (67%), pseudoaneurysm (58%), and contrast extravasation (30%). Exposed artery, pseudoaneurysm, and contrast extravasation were the 3 CTA findings related to outcomes. All of the pseudoaneurysm and contrast extravasation cases were associated with an exposed artery. An exposed artery was the most important prognostic predictor and could not be diagnosed on DSA. Patients without the 3 findings on CTA (group 1) had the best survival rate at 1-year follow-up, followed by patients with the 3 findings treated immediately by permanent artery occlusion (group 2). Patients with the 3 findings who had no immediate treatment (group 3) had the worst outcomes (P < .001 in group 1 vs group 3 and group 2 vs group 3; P = .056 group 1 vs group 2). CONCLUSIONS CTA, with its ability to diagnose an exposed artery compared with DSA, may offer important management and prognostic information in patients with impending carotid blowout.
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Affiliation(s)
- C-W Lee
- From the Department of Medical Imaging and Radiology (C.-W.L., C.-Y.Y., Y.-F.C., Y.-H.W., H.-M.L.), Hospital and Medical College, National Taiwan University, Taipei, Taiwan
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Nassiri N, Kapoor R, Qato K, Vitek J, Rosen RJ, Al Moutran H, Costantino PD, Green RM. Endovascular Palliation of Multivessel Blowout Syndrome in the Setting of a Nonresectable Neck Sarcoma. Ann Vasc Surg 2013; 27:111.e5-9. [DOI: 10.1016/j.avsg.2012.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 05/01/2012] [Indexed: 11/25/2022]
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Chard R, Monroe MM, Andersen PE. Hyoid osteoradionecrosis associated with carotid rupture: Report of 2 cases. Head Neck 2012; 35:E36-8. [DOI: 10.1002/hed.21847] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2011] [Indexed: 11/08/2022] Open
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Delayed carotid blow-out syndrome: a new complication of chemoradiotherapy treatment in pharyngolaryngeal carcinoma. The Journal of Laryngology & Otology 2012; 126:1189-91. [PMID: 22963758 DOI: 10.1017/s0022215112001910] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Carotid blow-out syndrome is one of the most devastating complications of head and neck carcinoma. It usually occurs as a post-operative complication or when the tumour compromises the vascular axis. METHODS AND RESULTS We report two patients who suffered carotid blow-out syndrome but who did not have the usual predisposing factors. Both patients had a pharyngolaryngeal carcinoma that was treated with chemoradiotherapy. Residual non-tumoural ulceration was seen along the lateral wall of the hypopharynx in both cases. This ulceration eventually reached the vascular axis, precipitating carotid rupture and death. CONCLUSION Residual non-tumoural ulceration of the lateral wall of the hypopharynx after chemoradiotherapy should be considered with the utmost caution. Once persistence of the tumour is excluded, surgery is indicated to protect the vascular axis, in order to prevent carotid blow-out syndrome.
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Okochi M, Okazaki M, Asato H. Oral antithrombotic treatment and postoperative thrombotic complications after head and neck reconstruction using free flaps. J Plast Surg Hand Surg 2012; 46:163-6. [DOI: 10.3109/2000656x.2012.697374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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43
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Rogers LR. Neurovascular complications of solid tumors and hematological neoplasms. HANDBOOK OF CLINICAL NEUROLOGY 2012; 105:805-23. [PMID: 22230535 DOI: 10.1016/b978-0-444-53502-3.00025-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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McGettigan B, Parkes W, Gonsalves C, Eschelman D, Keane W, Boon MS. The use of a covered stent in carotid blowout syndrome. EAR, NOSE & THROAT JOURNAL 2011; 90:E17. [PMID: 21500155 DOI: 10.1177/014556131109000415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Rupture of the extracranial carotid arteries or their major branches is known as carotid blowout syndrome (CBS). CBS is a well-recognized complication of cancer of the head and neck and subsequent radiation therapy. A few treatment modalities are available, including open ligation and different endovascular techniques, but questions regarding both the immediate and delayed complications of these procedures persist. In this case report, we describe the management of acute CBS in a 54-year-old man who had previously been treated for follicular thyroid carcinoma. The patient was hemorrhaging from a pseudoaneurysm of the left common carotid artery. A self-expanding polytetrafluoroethylene (Teflon) -covered stent was successfully deployed endovascularly, and this resulted in cessation of the bleeding and restoration of flow through the vessel. We examine the covered-stent approach to treating acute CBS, and we discuss other treatment approaches that have been described in the literature.
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Affiliation(s)
- Brian McGettigan
- Department of Otolaryngology-Head and Neck Surgery, Jefferson Medical College, Thomas Jefferson University, 925 Chestnut St., 6th Floor, Philadelphia, PA 19107, USA
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45
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Management of vascular complications of head and neck cancer. The Journal of Laryngology & Otology 2011; 126:111-5. [DOI: 10.1017/s0022215111002416] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Major vascular complications in patients with head and neck cancer have previously been thought of as terminal events. However, it is now possible to intervene in many situations, with benefits for quality of life as well as survival. Endovascular techniques have reduced morbidity and mortality in many situations, both emergency and elective.Method:We describe the techniques that can be employed in such situations, and present illustrative case reports. Life-threatening haemorrhage, carotid compression and radiation-induced carotid stenosis are all discussed.Conclusion:It is possible to predict where complications may arise, and to take prophylactic steps to allow treatment to continue. Early intervention can reduce both morbidity and mortality in this high-risk patient group.
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Shankar JJS, Maloney WJ, Vandorpe R. Amplatzer vascular plug for occlusion of parent artery in carotid blowout with active extravasation. Interv Neuroradiol 2011; 17:224-7. [PMID: 21696663 DOI: 10.1177/159101991101700214] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 04/17/2011] [Indexed: 11/15/2022] Open
Abstract
Carotid blowout is a devastating complication in patients with head and neck malignancy. Various treatments including high risk surgery, carotid stenting or carotid occlusion using either coils or detachable balloons have been described. The key for any treatment is the rapidity at which it can be performed. We describe treatment of common carotid blowout secondary to neoplastic infiltration using four Amplatzer vascular plugs deployed in less than ten minutes.
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Affiliation(s)
- J J S Shankar
- Department of Diagnostic Imaging, Division of Neuroradiology, QE II Hospital, Halifax, Canada.
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Alaraj A, Wallace A, Amin-Hanjani S, Charbel FT, Aletich V. Endovascular implantation of covered stents in the extracranial carotid and vertebral arteries: Case series and review of the literature. Surg Neurol Int 2011; 2:67. [PMID: 21697983 PMCID: PMC3115199 DOI: 10.4103/2152-7806.81725] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 04/26/2011] [Indexed: 12/14/2022] Open
Abstract
Background: Covered stents are used endovascularly to seal arterial wall defects while preserving vessel patency. This report describes our experience with the use of covered stents to treat cervical pathology, and a review of the literature in regards to this topic is presented. Case Description: Two patients presenting with the carotid blowout syndrome and one patient with a vertebrojugular fistula were treated with covered stents. This allowed for preservation of the vessel and was a treatment alternative to cerebral bypass. Conclusion: Covered stents provide a viable means of preserving the cervical vessels in selected patients; however, long-term follow-up is necessary to determine stent patency and permanency of hemostasis.
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Affiliation(s)
- Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, College of Medicine, Chicago IL, USA
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Shah H, Gemmete JJ, Chaudhary N, Pandey AS, Ansari SA. Acute life-threatening hemorrhage in patients with head and neck cancer presenting with carotid blowout syndrome: follow-up results after initial hemostasis with covered-stent placement. AJNR Am J Neuroradiol 2011; 32:743-7. [PMID: 21436338 DOI: 10.3174/ajnr.a2379] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND PURPOSE CSP in patients with HNC presenting with CBS can provide immediate hemostasis to prevent exsanguination. We evaluated the safety and efficacy of CSP to control acute life-threatening hemorrhage in patients with HNC presenting with CBS. MATERIALS AND METHODS We retrospectively reviewed 10 patients (7 men, 3 women; mean age, 59 years) with HNC presenting with acute life-threatening hemorrhage from CBS that was treated with CSP. We studied patient demographics, presentations, procedures, initial and delayed complications, and technical and clinical outcomes on follow-up. RESULTS All patients achieved immediate hemostasis following CSP. Periprocedural complications consisted of groin hematomas (n=2), acute limb ischemia requiring thrombectomy, and an asymptomatic temporal lobe hemorrhage. Imaging and clinical follow-up were available for a mean of 17.7 months (range, 1-60 months). Two patients remained asymptomatic with a patent stent and no evidence of rebleeding at 17 and 21 months, respectively. Recurrent hemorrhages requiring retreatment were encountered in 3 patients secondary to stent infections (30%) at mean duration of 8 months. Neurologic morbidity resulted from stent thrombosis and stroke at 8 months in a single patient. Mortality was unrelated to CSP but was a result of palliative hospice care (n=3) at a mean of 2 months or natural disease progression (n=1) with documented patency of the stent at 6 months. CONCLUSIONS Acute life-threatening hemorrhage from CBS related to advanced HNC can be safely and effectively treated with CSP. However, potential delayed ischemic or infectious complications are common in the exposed or infected neck.
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Affiliation(s)
- H Shah
- University of Michigan Medical School, Ann Arbor, Michigan, USA
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Wan WS, Lai V, Lau HY, Wong YC, Poon WL, Tan CB. Endovascular treatment paradigm of carotid blowout syndrome: review of 8-years experience. Eur J Radiol 2011; 82:95-9. [PMID: 21310571 DOI: 10.1016/j.ejrad.2011.01.061] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 01/03/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Endovascular treatment is effective in treating carotid blowout syndrome (CBS). We reviewed our experience in addressing CBS over eight years and presented an account of the treatment paradigm and management algorithm. METHOD All cases of CBS from 2003 to 2010 with endovascular treatment performed in our center were reviewed. 15 CBS in 14 patients were recruited. Based on our management algorithm, treatment regimen was stratified into deconstructive or constructive methods. Their clinical presentations, angiographic features, angiographic and clinical outcomes were reviewed. RESULTS 10 patients were treated with deconstructive method by means of permanent vessel occlusion (PVO) and 4 patients were treated with constructive method by means of placement of covered stent (n=3) or flow diverting device (n=1). Immediate hemostasis was achieved in all cases. 7 (50%) patients, in whom 5 treated with PVO and 2 with covered stent, had favorable outcomes and survived at a median follow-up period of 4 months (range: 1-84 months). CONCLUSION Permanent vessel occlusion remains the gold standard of treatment and tends to show a favorable long-term outcome. Off-label use of covered stent and flow-diverting device can produce satisfactory results should balloon occlusion test fail, but long-term follow up would be required for definitive assessment.
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Affiliation(s)
- Wing Suet Wan
- Department of Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong.
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50
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Powitzky R, Vasan N, Krempl G, Medina J. Carotid Blowout in Patients with Head and Neck Cancer. Ann Otol Rhinol Laryngol 2010; 119:476-84. [DOI: 10.1177/000348941011900709] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives The objective was to review the clinicopathologic features of carotid blowout syndrome (CBS) in patients with head and neck cancer (HNC) and present a management algorithm. Methods We reviewed all HNC patients with a diagnosis of CBS seen at our tertiary cancer hospital from 1994 to 2009 and performed a retrospective review of all English-language studies documenting CBS cases within the past 15 years. Results Eight patients with HNC developed CBS at our institution, and another 132 HNC patients were presented in 21 studies. Patients with CBS typically have a history of radiotherapy (89%), nodal metastasis (69%), and neck dissection (63%). This disease usually occurs proximal to the carotid bifurcation and is commonly associated with soft tissue necrosis in the neck (55%) and mucocutaneous fistulas (40%). Half of CBS patients present with sentinel bleeding, but 60% of patients will develop a life-threatening hemorrhage requiring emergent intervention. Over 90% of patients with CBS were treated with endovascular therapy, and surgical ligation was rarely indicated. The morbidity and mortality rates of patients with CBS are significant; only 23% have survived without evidence of disease. Conclusions Carotid blowout syndrome is uncommon and can be rapidly fatal without prompt diagnosis and intervention. Although endovascular treatment within the carotid system can have a significant risk of mortality and neurologic morbidity, it has become the treatment of choice for CBS.
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Affiliation(s)
- Rosser Powitzky
- Department of Otorhinolaryngology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Nilesh Vasan
- Department of Otorhinolaryngology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Greg Krempl
- Department of Otorhinolaryngology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Jesus Medina
- Department of Otorhinolaryngology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
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