title: Acute life-threatening hemorrhage in patients with head and neck cancer presenting with carotid blowout syndrome: follow-up results after initial hemostasis with covered-stent placement.
abstract: OBJECTIVE
  CSP in patients with HNC presenting with CBS can provide immediate hemostasis to prevent exsanguination. We evaluated the safety and efficacy of CSP to control acute life-threatening hemorrhage in patients with HNC presenting with CBS.
  
  
  METHODS
  We retrospectively reviewed 10 patients (7 men, 3 women; mean age, 59 years) with HNC presenting with acute life-threatening hemorrhage from CBS that was treated with CSP. We studied patient demographics, presentations, procedures, initial and delayed complications, and technical and clinical outcomes on follow-up.
  
  
  RESULTS
  All patients achieved immediate hemostasis following CSP. Periprocedural complications consisted of groin hematomas (n=2), acute limb ischemia requiring thrombectomy, and an asymptomatic temporal lobe hemorrhage. Imaging and clinical follow-up were available for a mean of 17.7 months (range, 1-60 months). Two patients remained asymptomatic with a patent stent and no evidence of rebleeding at 17 and 21 months, respectively. Recurrent hemorrhages requiring retreatment were encountered in 3 patients secondary to stent infections (30%) at mean duration of 8 months. Neurologic morbidity resulted from stent thrombosis and stroke at 8 months in a single patient. Mortality was unrelated to CSP but was a result of palliative hospice care (n=3) at a mean of 2 months or natural disease progression (n=1) with documented patency of the stent at 6 months.
  
  
  CONCLUSIONS
  Acute life-threatening hemorrhage from CBS related to advanced HNC can be safely and effectively treated with CSP. However, potential delayed ischemic or infectious complications are common in the exposed or infected neck.
authors: University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors: H
authors: H
authors: Shah
authors: J J
authors: JJ
authors: Gemmete
authors: N
authors: N
authors: Chaudhary
authors: A S
authors: AS
authors: Pandey
authors: S A
authors: SA
authors: Ansari
mesh_terms: D000208:Acute Disease; D000368:Aged; D000792:Angiography; D017130:Angioplasty; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D020099:Coated Materials, Biocompatible; D016638:Critical Illness / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D006487:Hemostasis; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents
chemical_list: D020099:Coated Materials, Biocompatible