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Carotid blowout syndrome: modern trends in management

Authors Suárez C, Fernández-Alvarez V, Hamoir M, Mendenhall WM, Strojan P, Quer M, Silver CE, Rodrigo JP, Rinaldo A, Ferlito A

Received 13 July 2018

Accepted for publication 12 October 2018

Published 13 November 2018 Volume 2018:10 Pages 5617—5628

DOI https://doi.org/10.2147/CMAR.S180164

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 3

Editor who approved publication: Dr Antonella D'Anneo


Carlos Suárez,1,2,* Verónica Fernández-Alvarez,3,* Marc Hamoir,4 William M Mendenhall,5 Primoz Strojan,6 Miquel Quer,7 Carl E Silver,8 Juan P Rodrigo,1,2,9 Alessandra Rinaldo,10 Alfio Ferlito11

1Head & Neck Cancer Laboratory, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; 2Head & Neck Cancer Laboratory, Instituto Universitario de Oncología del Principado de Asturias, CIBERONC, University of Oviedo, Oviedo, Spain; 3Department of Vascular Surgery, Hospital Universitario de Cabueñes, Gijón, Spain; 4Department of Head and Neck Surgery, Head and Neck Oncology Program, King Albert II Cancer Institute, St Luc University Hospital, Brussels, Belgium; 5Department of Radiation Oncology, University of Florida, Gainesville, FL, USA; 6Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia; 7Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain; 8Department of Surgery, University of Arizona, Phoenix, AZ, USA; 9Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain; 10University of Udine School of Medicine, Udine, Italy; 11International Head and Neck Scientific Group Padua, Italy

*These authors contributed equally to this work

Abstract: Carotid blowout syndrome (CBS) refers to rupture of the carotid artery and is an uncommon complication of head and neck cancer that can be rapidly fatal without prompt diagnosis and intervention. CBS develops when a damaged arterial wall cannot sustain its integrity against the patient’s blood pressure, mainly in patients who have undergone surgical procedures and radiotherapy due to cancer of the head and neck, or have been reirradiated for a recurrent or second primary tumor in the neck. Among patients irradiated prior to surgery, CBS is usually a result of wound breakdown, pharyngocutaneous fistula and infection. This complication has often been fatal in the past, but at the present time, early diagnosis and modern technology applied to its management have decreased morbidity and mortality rates. In addition to analysis of the causes and consequences of CBS, the purpose of this paper is to critically review methods for early diagnosis of this complication and establish individualized treatment based on endovascular procedures for each patient.

Keywords: carotid blowout, head and neck cancer, reirradiation, surgery, covered stents, embolization

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