title: Two cases of emergent endovascular treatment for carotid blowout syndrome after free flap reconstruction for neck cancer.
abstract: Carotid blowout is a devastating complication in patients with head and neck malignancy, and is associated with high morbidity and mortality. For patients with bleeding originating in the internal or common carotid artery, treatment options are limited. These include the endovascular remodelling strategies using a stent or embolization of the aneurysm with coils. We describe two cases of pseudoaneurysmal rupture in the common carotid artery with massive bleeding in patients with head and neck malignancies and a history of long-term radiation treatment. They underwent immediate coil embolization and wall stent deployment and, which resulted in the successful control of bleeding. Although these endovascular treatments often result in recurrent carotid blowout syndrome, they can be useful and effective in treating emergent carotid rupture in patients for whom balloon occlusion test is contraindicated.
authors.affiliation: Department of Plastic and Reconstructive Surgery (Chairman: Fujioka Masaki MD, PhD), National Hospital Organization, Nagasaki Medical Center, Nagasaki, Japan. mfujioka@nmc.hosp.go.jp
authors.forename: Masaki
authors.initials: M
authors.lastname: Fujioka
authors.forename: Hideaki
authors.initials: H
authors.lastname: Takahata
mesh_terms: D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000628:therapy*; D017542:Aneurysm, Ruptured / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000532:radiotherapy; D002340:Carotid Artery Diseases / Q000209:etiology / Q000628:therapy*; D017536:Carotid Artery, Common; D002342:Carotid Artery, External; D020215:Carotid Artery, Internal, Dissection / Q000628:therapy; D016371:Cranial Irradiation / Q000009:adverse effects*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000150:complications / Q000209:etiology; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D010019:Osteomyelitis / Q000150:complications / Q000209:etiology; D011859:Radiography; D012883:Skin Ulcer / Q000150:complications / Q000601:surgery; D015607:Stents