title: Endovascular management of carotid blowout syndrome in patients with head and neck cancers.
abstract: Endovascular treatments for carotid blowout syndrome (CBS) have been advocated by interventional neuroradiologists. We therefore retrospectively evaluated the efficacy of endovascular treatments of CBS in 16 patients with head and neck cancers (HNC). The clinical, treatment and outcome data were evaluated in 16 HNC patients with CBS, all of whom underwent permanent embolization or covered stent graft of the affected carotid artery. All patients received multimodal treatments, including radiotherapy (mean total dose, 78.5 Gy). CBS was caused by tumor carotid invasion in 8 patients, pharyngocutaneous fistula in 7, and laryngeal chondroradionecrosis in 1, with the external and common carotid arteries being the most common rupture sites. CBS was occluded by embolization or revascularized by covered stent placement. Immediate hemostasis was achieved in all patients; however, 7 patients had recurrent CBS, all of whom were retreated effectively by endovascular management. Three patients had strokes and four had extrusion of intervention materials from the infected wounds. Most patients died of tumor progression, with a mean survival time of five months from initial CBS; only two patients survived. Endovascular therapy, by both permanent occlusion and stent grafts, is effective in hemostasis of CBS but its long-term efficacy may not be high in these HNC patients.
authors.affiliation: Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Jong-Lyel
authors.initials: JL
authors.lastname: Roh
authors.forename: Dae Chul
authors.initials: DC
authors.lastname: Suh
authors.forename: Mi Ra
authors.initials: MR
authors.lastname: Kim
authors.forename: Jeong Hyun
authors.initials: JH
authors.lastname: Lee
authors.forename: Jin Woo
authors.initials: JW
authors.lastname: Choi
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Soon Yuhl
authors.initials: SY
authors.lastname: Nam
authors.forename: Sang Yoon
authors.initials: SY
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000628:therapy*; D002340:Carotid Artery Diseases / Q000209:etiology / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D015607:Stents; D013530:Surgical Wound Infection / Q000401:mortality; D013577:Syndrome; D016896:Treatment Outcome