title: Endovascular therapy for the carotid blowout syndrome in head and neck surgical patients: diagnostic and managerial considerations.
abstract: OBJECTIVE
  To review our institution's recent experience with patients with carotid blowout syndrome who were referred for emergency diagnostic angiography and endovascular therapy.
  
  
  METHODS
  Eighteen consecutive patients who had had surgery for cancer of the head and neck and in whom carotid blowout syndrome had occurred were referred to our service in accordance with a standardized protocol.
  
  
  RESULTS
  Twenty-three angiographic pathoetiologic conditions were diagnosed in the 18 patients; the majority of these were pseudoaneurysms involving various segments of the carotid system. Multiple lesions were detected in five patients. Most patients were treated by means of permanent balloon occlusion; in 8 patients with either multiple lesions or impending rupture requiring flap reconstruction, a composite permanent balloon occlusion of the affected carotid system was performed. Hyperacute hemorrhages were arrested in all cases. Hemorrhages reoccurred in 2 cases, and in 2 patients who had permanent balloon occlusion of the internal carotid artery, transient ischemic attacks occurred, which appeared to be related to temporary collateral reserve failure. No permanent neurologic complications ensued.
  
  
  CONCLUSIONS
  Our recent experience with carotid blowout syndrome suggests that this clinical diagnosis represents a heterogeneous group of angiographic pathoetiologies that the physician should evaluate carefully before proceeding with endovascular therapy. Specific endovascular approaches depend on the pathoetiologic mechanism of active or impending hemorrhage and the urgency with which intervention is required.
authors: Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT 06510, USA.
authors: J C
authors: JC
authors: Chaloupka
authors: C M
authors: CM
authors: Putman
authors: M J
authors: MJ
authors: Citardi
authors: D A
authors: DA
authors: Ross
authors: C T
authors: CT
authors: Sasaki
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000628:therapy*; D015901:Angiography, Digital Subtraction; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D017536:Carotid Artery, Common; D002342:Carotid Artery, External; D002343:Carotid Artery, Internal; D003097:Collateral Circulation; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000628:therapy; D015641:Radiography, Interventional; D012008:Recurrence; D013524:Surgical Flaps; D016896:Treatment Outcome