Chang Feng-Chi, Lirng Jiing-Feng, Luo Chao-Bao, Wang Shuu-Jiun, Wu Hsiu-Mei, Guo Wan-Yuo, Teng Michael Mu Huo, Chang Cheng-Yen
Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
J Vasc Surg. 2008 May;47(5):936-45. doi: 10.1016/j.jvs.2007.12.030. Epub 2008 Mar 6.
This study retrospectively evaluated the technical and hemostatic outcomes of reconstructive and deconstructive endovascular management in patients with head and neck cancers associated with carotid blowout syndrome (CBS).
Twenty-four patients with head and neck cancers with CBS involving the main trunk of carotid artery underwent endovascular therapy. This included reconstructive management with self-expandable stent grafts to preserve the diseased carotid artery in 11 patients and deconstructive management with balloons, coils, or acrylic adhesives to occlude the diseased carotid artery in 13 patients. Based on clinical severity and therapeutic priority, we classified CBS in our patients into two groups: acute or impending and threatened. The angiographic severity was graded from 0 to 3. Evaluation of technical outcome included technical success, initial and delayed complications, and patency of stent graft in the reconstructive group. The hemostatic outcome was evaluated by immediate hemostatic result, rebleeding, and duration of hemostasis. Sex, age, clinical and angiographic severities, local wound complications, and location of the pathologic lesion were examined as predictors of the technical and hemostatic outcomes of endovascular management by using Cox regression method.
Technical success and immediate hemostasis were achieved in all patients of both groups. Initial complications during the procedures were encountered in four patients (36.4%) who underwent reconstructive management and in one patient (7.7%) who underwent deconstructive management (P = .142). Delayed complications during the follow-up were seen in one patient (9.1%) with reconstructive management and one patient (7.7%) with deconstructive management (P > .99). Rebleeding occurred in five patients (45.5%) in the reconstructive management group and in three patients (23.1%) in the deconstructive management group (P = .659). The mean duration of hemostasis after initial reconstructive and deconstructive management was 4.0 +/- 8.1 and 8.5 +/- 10.1 months, respectively (P = .249). Rebleeding was noted in 7 of 11 patients (63.6%) with acute CBS and in 1 of 13 patients (7.7%) with impending and threatened CBS (P = .008).
There is no significant difference in technical and hemostatic outcomes between the reconstructive and deconstructive endovascular management methods. Hemostatic results were influenced by clinical severity. The rebleeding rate is higher in patients with advanced and acute clinical severity.
本研究回顾性评估了头颈部癌合并颈动脉破裂综合征（CBS）患者行重建性和破坏性血管内治疗的技术及止血效果。
24名头颈部癌合并CBS且累及颈动脉主干的患者接受了血管内治疗。其中11例患者采用可自膨胀支架移植物进行重建性治疗以保留病变颈动脉，13例患者采用球囊、弹簧圈或丙烯酸粘合剂进行破坏性治疗以闭塞病变颈动脉。根据临床严重程度和治疗优先级，我们将患者的CBS分为两组：急性或即将发生型以及有风险型。血管造影严重程度分为0至3级。技术效果评估包括技术成功率、早期和延迟并发症以及重建组中支架移植物的通畅情况。止血效果通过即时止血结果、再出血情况和止血持续时间进行评估。采用Cox回归方法，将性别、年龄、临床和血管造影严重程度、局部伤口并发症以及病理病变位置作为血管内治疗技术和止血效果的预测因素进行分析。
两组所有患者均实现了技术成功和即时止血。接受重建性治疗的4例患者（36.4%）和接受破坏性治疗的1例患者（7.7%）在手术过程中出现了早期并发症（P = 0.142）。随访期间，接受重建性治疗的1例患者（9.1%）和接受破坏性治疗的1例患者（7.7%）出现了延迟并发症（P > 0.99）。重建性治疗组有5例患者（45.5%）发生再出血，破坏性治疗组有3例患者（23.1%）发生再出血（P = 0.659）。首次重建性和破坏性治疗后的平均止血持续时间分别为4.0±8.1个月和8.5±10.1个月（P = 0.249）。11例急性CBS患者中有7例（63.6%）发生再出血，13例即将发生和有风险型CBS患者中有1例（7.7%）发生再出血（P = 0.008）。
重建性和破坏性血管内治疗方法在技术和止血效果方面无显著差异。止血结果受临床严重程度影响。临床严重程度为晚期和急性的患者再出血率更高。
