title: Management of pseudoaneurysms of the internal carotid artery in postirradiated nasopharyngeal carcinoma patients.
abstract: OBJECTIVE
  Massive epistaxis due to ruptured pseudoaneurysm of the internal carotid artery (ICA) is an often fatal complication of radiation treatment for patients with nasopharyngeal carcinoma. We review the clinical characteristics and predictors of survival in patients suffering from this serious complication after radiotherapy.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Clinical records and radiological investigations of postirradiated NPC patients with ICA pseudoaneurysm diagnosed with digital subtraction angiography in Queen Mary Hospital from January 2003 to December 2012 were reviewed. Risk factors analyzed for survival included gender, size of initial tumor, history of second course of radiotherapy, history of previous maxillary swing nasopharyngectomy, presence of persistent disease, successful initial hemostasis, successful airway control, and endovascular treatment.
  
  
  RESULTS
  Twenty-six were included in the analysis. Twenty-three patients underwent endovascular treatment, and 20 (87%) had successful control of the bleeding. Eighteen (69%) patients survived. Univariate analysis showed that successful temporary control of bleeding and airway control were associated with survival.
  
  
  CONCLUSIONS
  Prompt bleeding control and airway management is necessary to improve survival. Endovascular treatment is a good definitive treatment option with a high success rate.
authors.affiliation: Division of Otorhinolaryngology -, Head and Neck Surgery, Hong Kong.
authors.forename: Jacky Wai-Kei
authors.initials: JW
authors.lastname: Lam
authors.forename: Jimmy Yu-Wai
authors.initials: JY
authors.lastname: Chan
authors.forename: Wai-Man
authors.initials: WM
authors.lastname: Lui
authors.forename: Wai-Kuen
authors.initials: WK
authors.lastname: Ho
authors.forename: Raymond
authors.initials: R
authors.lastname: Lee
authors.forename: Raymond King-Yin
authors.initials: RK
authors.lastname: Tsang
mesh_terms: D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D015901:Angiography, Digital Subtraction; D002277:Carcinoma; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging* / Q000601:surgery; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
keywords: Carotid blowout; carotid artery pseudoaneurysm; complication of radiotherapy; epistaxis; nasopharyngeal carcinoma