title: Transarterial endovascular treatment in the management of life-threatening carotid blowout syndrome in head and neck cancer patients: review of the literature.
abstract: OBJECTIVE
  Carotid blowout syndrome is a rare but devastating complication in patients with head and neck malignancy, and is associated with high morbidity and mortality. Bleeding from the carotid artery or its branches is a well-recognized complication following treatment or recurrence of head and neck cancer. It is an emergency situation, and the classical approach to save the patient's life is to ligate the carotid artery. But the surgical treatment is often technically difficult. Endovascular therapies were recently reported as good alternatives to surgical ligation.
  
  
  METHODS
  Retrospective review of three cases of acute or threatened carotid hemorrhage managed by endovascular therapies.
  
  
  RESULTS
  Two patients presented with acute carotid blowout, and one patient with a sentinel bleed. Two patients had previously been treated with surgery and chemo radiation. One patient was treated by chemo radiation. Two had developed pharyngocutaneous fistulas, and one had an open necrosis filled wound that surrounded the carotid artery. In two patients, stent placement resolved the acute hemorrhage. In one patient, superselective embolization was done. Mean duration follow-up was 10.2 months. No patient had residual sequelae of stenting or embolization.
  
  
  CONCLUSIONS
  Management of carotid blow syndrome is very critical and difficult. A multidisciplinary approach is very important in the management of carotid blow syndrome. Correct and suitable management can be life saving. An endovascular technique is a good and effective alternative with much lower morbidity rates than surgical repair or ligation.
authors.affiliation: Head and Neck Department, 706, rue de Gozée, 6110 Montigny-le-Tilleul, Belgium. Electronic address: dequanter@pandora.be.
authors.forename: D
authors.initials: D
authors.lastname: Dequanter
authors.forename: M
authors.initials: M
authors.lastname: Shahla
authors.forename: P
authors.initials: P
authors.lastname: Paulus
authors.forename: C
authors.initials: C
authors.lastname: Aubert
authors.forename: P
authors.initials: P
authors.lastname: Lothaire
mesh_terms: D000208:Acute Disease; D019917:Blood Vessel Prosthesis Implantation; D002340:Carotid Artery Diseases / Q000209:etiology / Q000628:therapy*; D004621:Embolization, Therapeutic; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000628:therapy; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D012422:Rupture, Spontaneous; D015607:Stents
keywords: Cancer cervico-facial; Carotid blow syndrome; Head and neck cancer; Rupture carotidienne