title: Outcomes of interventions for carotid blowout syndrome in patients with head and neck cancer.
abstract: BACKGROUND
  The purpose of this study was to examine outcomes of a patient cohort undergoing intervention for carotid blowout syndrome associated with head and neck cancer.
  
  
  METHODS
  Patients with head and neck cancer who presented with carotid distribution bleeding from 2000 to 2014 were identified in the medical record. Primary outcomes were short- and midterm mortality and recurrent bleeding. Standard statistical methods and survival analysis were used to analyze study population characteristics and outcomes.
  
  
  RESULTS
  Thirty-seven patients were included in the study. The mean age was 60.1 ± 11.4 years (74% male). All malignancies were squamous cell type, stage IV, in a variety of primary locations: 32% oral cavity, 24% larynx, 16% superficial neck, with the remainder in the oropharynx, nasopharynx, and hypopharynx. Fifty-one percent of bleeds were of common carotid, 29% external carotid, and 19% internal carotid origin. Among the patients, 68% presented with acute hemorrhage, 24% with impending bleed, and 8% with threatened bleed. All patients underwent intervention: 38% received endovascular coil embolization, 30% stent grafts, 22% surgical ligation, and 10% primary vessel repair or bypass grafting. Although major complications were rare, 10.8% of patients had perioperative stroke. Sixteen recurrent bleeding episodes involving 12 arteries occurred in 11 patients (29.73%). Median rebleeding time was 7 days (interquartile range, 6-49). Estimated recurrent bleeding risk at 30 days and 6 months was 24% and 34%, respectively. Of the patients, 91.9% survived to hospital discharge. The 90-day and 1-year estimated survivals were 60.9% and 36.6%, respectively.
  
  
  CONCLUSIONS
  Carotid blowout syndrome associated with head and neck cancer carries poor mid- and long-term prognoses; however, mortality may be related more to the advanced stage of disease rather than carotid involvement or associated intervention. Both surgical and endovascular approaches may be efficacious in cases of acute hemorrhage but carry a significant risk of periprocedural stroke and recurrent bleeding.
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine, Pittsburgh, Pa. Electronic address: liangnl@upmc.edu.
authors.forename: Nathan L
authors.initials: NL
authors.lastname: Liang
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pa.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Guedes
authors.affiliation: Department of Otolaryngology, University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine, and the VA Pittsburgh Health System, Pittsburgh, Pa.
authors.forename: Umamaheswar
authors.initials: U
authors.lastname: Duvvuri
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine, Pittsburgh, Pa.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Singh
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine, Pittsburgh, Pa.
authors.forename: Rabih A
authors.initials: RA
authors.lastname: Chaer
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine, Pittsburgh, Pa.
authors.forename: Michel S
authors.initials: MS
authors.lastname: Makaroun
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine, Pittsburgh, Pa.
authors.forename: Ulka
authors.initials: U
authors.lastname: Sachdev
mesh_terms: D000328:Adult; D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008026:Ligation; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009367:Neoplasm Staging; D019106:Postoperative Hemorrhage / Q000209:etiology; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D000077195:Squamous Cell Carcinoma of Head and Neck; D020521:Stroke / Q000209:etiology; D013577:Syndrome; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome