Multistep and Multidisciplinary Management for Post-irradiated Carotid Blowout Syndrome in a Young Patient With Oropharyngeal Carcinoma: A Case Report

Ann Vasc Surg. 2020 Aug:67:565.e1-565.e5. doi: 10.1016/j.avsg.2020.02.023. Epub 2020 Mar 21.

Abstract

Background: Carotid blowout syndrome is a severe complication of head and neck cancer, associated with high mortality and morbidity.

Methods: We present a case of acute hemorrhage from the carotid artery of a 59-year-old man with a history of chemoradiotherapy for lingual base and oropharyngeal squamous cell carcinoma. The case was managed by a staged multidisciplinary approach of open arterial reconstruction, after initial endovascular hemorrhage control using stent graft.

Results: The patient was discharged to home with patent carotid artery, no sign of infection or bleeding, and autonomous ambulation. A CT/PET scan performed 6 months later confirmed healing and absence of tumor recurrence.

Conclusions: A multidisciplinary approach involving vascular surgeons, ENT surgeons, plastic and maxillofacial surgeons is particularly appropriate in the management of carotid blowout syndrome to warrant a durable and effective repair of all the anatomical structures involved.

Publication types

  • Case Reports

MeSH terms

  • Blood Vessel Prosthesis
  • Blood Vessel Prosthesis Implantation* / instrumentation
  • Carotid Artery Injuries / diagnostic imaging
  • Carotid Artery Injuries / etiology
  • Carotid Artery Injuries / surgery*
  • Chemoradiotherapy / adverse effects*
  • Endovascular Procedures* / instrumentation
  • Hemorrhage / diagnostic imaging
  • Hemorrhage / etiology
  • Hemorrhage / surgery*
  • Humans
  • Male
  • Middle Aged
  • Myocutaneous Flap
  • Oropharyngeal Neoplasms / complications
  • Oropharyngeal Neoplasms / pathology
  • Oropharyngeal Neoplasms / therapy*
  • Radiation Injuries / diagnostic imaging
  • Radiation Injuries / etiology
  • Radiation Injuries / surgery*
  • Saphenous Vein / transplantation*
  • Squamous Cell Carcinoma of Head and Neck / complications
  • Squamous Cell Carcinoma of Head and Neck / pathology
  • Squamous Cell Carcinoma of Head and Neck / therapy*
  • Stents
  • Syndrome
  • Treatment Outcome