title: Carotid blowout syndrome: endovascular management of acute hemorrhage with tapering overlapped covered stents.
abstract: Carotid blowout is a rare fatal complication most commonly observed in head and neck cancer patients, especially after radiation therapy. Traditional surgical approaches carry extremely high morbidity and mortality rates. We present a case of acute hemorrhage from extracranial carotid artery in a 64-year-old man with history of total laryngectomy, tracheostomy, and chemoradiotherapy for laryngeal cancer. Tumor was noted to be encasing and eroding into the internal and common carotid artery with a large soft tissue neck defect. Hemorrhage was successfully controlled employing 3 Viabahn covered stents of increasing diameter in the internal and common carotid artery in an overlapping fashion under local anesthesia. Deployment of tapering overlapped covered stents in common and internal carotid artery may safely be performed to obtain endovascular control of active hemorrhage in a hostile neck.
authors.affiliation: Division of Vascular Surgery, Department of Surgical Services, Brookdale University Hospital and Medical Center, Brooklyn, NY. Electronic address: bfarivar@chpnet.org.
authors.forename: Behzad S
authors.initials: BS
authors.lastname: Farivar
authors.affiliation: Division of Vascular Surgery, Department of Surgical Services, Brookdale University Hospital and Medical Center, Brooklyn, NY.
authors.forename: Dong H
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Division of Vascular Surgery, Department of Surgical Services, Brookdale University Hospital and Medical Center, Brooklyn, NY.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Khalil
authors.affiliation: Division of Vascular Surgery, Department of Surgical Services, Brookdale University Hospital and Medical Center, Brooklyn, NY.
authors.forename: Sunil
authors.initials: S
authors.lastname: Abrol
authors.affiliation: Division of Vascular Surgery, Department of Surgical Services, Brookdale University Hospital and Medical Center, Brooklyn, NY.
authors.forename: Lucio
authors.initials: L
authors.lastname: Flores
mesh_terms: D000208:Acute Disease; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000528:radiation effects*; D057510:Endovascular Procedures / Q000295:instrumentation*; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011878:Radiotherapy / Q000009:adverse effects; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome