title: Endovascular management of carotid blowout.
abstract: OBJECTIVE
  To highlight pertinent aspects of emergent endovascular management of carotid rupture, or carotid blowout syndrome (CBS), an emergent, life-threatening complication of head and neck cancer and its treatments.
  
  
  METHODS
  A retrospective chart review was conducted of all patients with carotid blowouts at the authors' institution from 2008-2010. A systematic literature review was also performed.
  
  
  RESULTS
  Eight patients (three women and five men) with an average age of 61 years (range 47-78 years) were reviewed. Seven patients had a positive history for squamous cell carcinoma of the neck, and five patients had active malignant disease. Carotid arterial deconstruction using liquid embolic material, coil embolization, or both achieved immediate hemostasis in every case (100%). No patients died as a result of their initial hemorrhage, but one patient had lethal hemorrhage at 1 day postoperatively. Two patients experienced nonlethal postoperative complications. At an average follow-up of 3 months (range<1-8 months), three patients were alive, three had died as a result of their underlying disease, and two had died of other causes.
  
  
  CONCLUSIONS
  The treatment of patients with terminal malignant disease and CBS should provide maximum relief and minimize the risks of repeat surgery, morbidity, and mortality. Endovascular management of CBS with deconstructive techniques achieves immediate hemostasis and definitive treatment. The risks of intraoperative mortality and recurrent hemorrhage are low.
authors: Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors: Benjamin
authors: B
authors: Zussman
authors: L Fernando
authors: LF
authors: Gonzalez
authors: Aaron
authors: A
authors: Dumont
authors: Stavropoula
authors: S
authors: Tjoumakaris
authors: Robert
authors: R
authors: Rosenwasser
authors: David
authors: D
authors: Hasan
authors: David
authors: D
authors: Cognetti
authors: Rita
authors: R
authors: Axelrod
authors: Pascal
authors: P
authors: Jabbour
mesh_terms: D000368:Aged; D000465:Algorithms; D000792:Angiography; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D002342:Carotid Artery, External / Q000000981:diagnostic imaging / Q000601:surgery; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009361:Neoplasm Invasiveness; D010039:Otorhinolaryngologic Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications / Q000628:therapy; D012189:Retrospective Studies; D012422:Rupture, Spontaneous