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Contemporary management of carotid blowout syndrome utilizing endovascular techniques.
- Source :
-
The Laryngoscope [Laryngoscope] 2017 Feb; Vol. 127 (2), pp. 383-390. Date of Electronic Publication: 2016 Nov 30. - Publication Year :
- 2017
-
Abstract
- Objectives/hypothesis: To illustrate complex interdisciplinary decision making and the utility of modern endovascular techniques in the management of patients with carotid blowout syndrome (CBS).<br />Study Designs: Retrospective chart review.<br />Methods: Patients treated with endovascular strategies and/or surgical modalities were included. Control of hemorrhage, neurological, and survival outcomes were studied.<br />Results: Between 2004 and 2014, 33 patients had 38 hemorrhagic events related to head and neck cancer that were managed with endovascular means. Of these, 23 were localized to the external carotid artery (ECA) branches and five localized to the ECA main trunk; nine were related to the common carotid artery (CCA) or internal carotid artery (ICA), and one event was related to the innominate artery. Seven events related to the CCA/ICA or innominate artery were managed with endovascular sacrifice, whereas three cases were managed with a flow-preserving approach (covered stent). Only one patient developed permanent hemiparesis. In two of the three cases where the flow-preserving approach was used, the covered stent eventually became exposed via the overlying soft tissue defect, and definitive management using carotid revascularization or resection was employed to prevent further hemorrhage. In cases of soft tissue necrosis, vascularized tissues were used to cover the great vessels as applicable.<br />Conclusions: The use of modern endovascular approaches for management of acute CBS yields optimal results and should be employed in a coordinated manner by the head and neck surgeon and the neurointerventionalist.<br />Level of Evidence: 4. Laryngoscope, 2016 127:383-390, 2017.<br /> (© 2016 The American Laryngological, Rhinological and Otological Society, Inc.)
- Subjects :
- Aged
Algorithms
Carcinoma, Squamous Cell mortality
Carotid Artery Diseases mortality
Combined Modality Therapy
Computed Tomography Angiography
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neoplasm Recurrence, Local complications
Neoplasm Recurrence, Local mortality
Neoplasm Recurrence, Local therapy
Oral Hemorrhage mortality
Otorhinolaryngologic Neoplasms mortality
Platelet Aggregation Inhibitors administration & dosage
Risk Factors
Surgical Flaps
Survival Rate
Veins transplantation
Carcinoma, Squamous Cell complications
Carcinoma, Squamous Cell therapy
Carotid Artery Diseases etiology
Carotid Artery Diseases therapy
Carotid Artery, External
Carotid Artery, Internal
Embolization, Therapeutic methods
Endovascular Procedures methods
Interdisciplinary Communication
Intersectoral Collaboration
Oral Hemorrhage etiology
Oral Hemorrhage therapy
Otorhinolaryngologic Neoplasms complications
Otorhinolaryngologic Neoplasms therapy
Septal Occluder Device
Stents
Subjects
Details
- Language :
- English
- ISSN :
- 1531-4995
- Volume :
- 127
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- The Laryngoscope
- Publication Type :
- Academic Journal
- Accession number :
- 27900766
- Full Text :
- https://doi.org/10.1002/lary.26144