Endovascular management of hemorrhage in patients with head and neck cancer.
OBJECTIVE
To present selective endovascular embolization as a therapeutic alternative to surgical ligation in the management of hemorrhage in patients with head and neck squamous cell carcinoma.


METHODS
Retrospective chart review of patients with head and neck cancer and significant hemorrhage who were treated with selective endovascular embolization.


METHODS
A university medical center.


METHODS
A total of 12 patients, aged 26 to 72 years, with 13 episodes of hemorrhage were treated at Oregon Health Sciences University, Portland, between November 1991 and January 1996.


METHODS
All patients underwent angiography with selective endovascular embolization at the interventional radiology suite using a combination of endovascular balloons, platinum coils, and microparticles.


METHODS
All charts were reviewed for diagnosis, treatment, factors that may have contributed to hemorrhage, bleeding site, therapeutic measures, control of hemorrhage, postembolization course, complications, and number of hospital days.


RESULTS
The cause of the bleeding was tumor in 5 patients, pharyngocutaneous fistula in 4 patients, radiation necrosis in 3 patients, and postoperative complication in 1 patient. Bleeding arose from the common carotid artery in 4 patients, external carotid artery and its branches in 8 patients, and internal jugular vein in 1 patient. Hemorrhage was successfully controlled in all patients; a permanent left-sided hemiplegia and facial weakness developed in 1 patient. There were no recurrences of hemorrhage. All patients were discharged from the hospital.


CONCLUSIONS
Angiography with selective embolization is a safe and effective alternative to surgical ligation for control of hemorrhage in patients with squamous cell carcinoma of the head and neck.
Morrissey
D D
DD
Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, USA.
Andersen
P E
PE
Nesbit
G M
GM
Barnwell
S L
SL
Everts
E C
EC
Cohen
J I
JI
D000328:Adult; D000368:Aged; D000792:Angiography; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000628:therapy; D004621:Embolization, Therapeutic; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000628:therapy; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies