Carotid blowout in patients with head and neck cancer.
OBJECTIVE
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.
Powitzky
Rosser
R
Department of Otorhinolaryngology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA.
Vasan
Nilesh
N
Krempl
Greg
G
Medina
Jesus
J
D000368:Aged; D000465:Algorithms; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000473:pathology / Q000532:radiotherapy; D002340:Carotid Artery Diseases / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D017577:Cutaneous Fistula / Q000453:epidemiology; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000473:pathology / Q000532:radiotherapy; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors