Jong Marrigje A de, Candanedo Carlos, Gross Menachem, Cohen José E
Department of Otolaryngology/Head and Neck Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Int Arch Otorhinolaryngol. 2019 Apr;23(2):172-177. doi: 10.1055/s-0038-1676660. Epub 2019 Mar 1.
Acute carotid blowout syndrome (aCBS) is a severe complication of head and neck cancer (HNC). It can be defined as a rupture of the extracranial carotid arteries, or one of their branches, that causes life-threatening hemorrhage, and which nowadays can be treated with urgent endovascular intervention. We retrospectively evaluate the endovascular management of aCBS and its outcome in years of survival. Retrospectively, we describe our experience with endovascular control of aCBS in patients treated for HNC. We review the characteristics, pathology, endovascular treatment and morbidity and assess the gain in life years. Nine individuals were included in this study. Four patients had been previously diagnosed with laryngeal squamous cell carcinoma (SCC), one with paranasal SCC, one with nasopharyngeal carcinoma and three with oral or maxillary adenocarcinoma. All subjects underwent radiotherapy and surgical excision to different extents. Twelve endovascular procedures were performed for injuries to the internal carotid artery ( = 3; 25%), external carotid artery ( = 1; 7%) or one of their branches ( = 8; 67%). Deconstructive methods were used in nine procedures, and three procedures were mainly reconstructive with deployment of covered stents. Total control of bleeding was achieved in all individuals with no intraprocedural complications. Endovascular therapy is an effective alternative for the management of exsanguinating CBS. In our series, this palliative therapy increased the overall patient survival by an estimated 9 months.
急性颈动脉破裂综合征（aCBS）是头颈癌（HNC）的一种严重并发症。它可被定义为颅外颈动脉及其分支之一的破裂，导致危及生命的出血，如今可通过紧急血管内介入治疗。我们回顾性评估aCBS的血管内治疗及其生存年限的结果。回顾性地，我们描述了在接受HNC治疗的患者中对aCBS进行血管内控制的经验。我们回顾了患者的特征、病理、血管内治疗和发病率，并评估了生命年限的增加情况。本研究纳入了9名患者。4例患者先前被诊断为喉鳞状细胞癌（SCC），1例为鼻旁SCC，1例为鼻咽癌，3例为口腔或上颌腺癌。所有受试者均接受了不同程度的放疗和手术切除。针对颈内动脉损伤进行了12次血管内手术（n = 3；25%），颈外动脉损伤（n = 1；7%）或其分支之一的损伤（n = 8；67%）。9次手术采用了解构性方法，3次手术主要是通过植入覆膜支架进行重建。所有患者均实现了出血的完全控制，术中无并发症。血管内治疗是治疗出血性CBS的一种有效替代方法。在我们的系列研究中，这种姑息治疗使患者的总体生存期估计延长了9个月。
