ENDOVASCULAR THERAPY FOR THE CAROTID BLOWOUT SYNDROME IN HEAD AND NECK SURGICAL PATIENTS - DIAGNOSTIC AND MANAGERIAL CONSIDERATIONS

PURPOSE: To review our institution's recent experience with patients w ith carotid blowout syndrome who were referred for emergency diagnosti c angiography and endovascular therapy. METHODS: Eighteen consecutive patients who had had surgery for cancer of the head and neck and in wh om carotid blowout syndrome had occurred were referred to our service in accordance with a standardized protocol. RESULTS: Twenty-three angi ographic pathoetiologic conditions were diagnosed in the 18 patients; the majority of these were pseudoaneurysms involving various segments of the carotid system. Multiple lesions were detected in five patients . Most patients were treated by means of permanent balloon occlusion; in 8 patients with either multiple lesions or impending rupture requir ing flap reconstruction, a composite permanent balloon occlusion of th e affected carotid system was performed. Hyperacute hemorrhages were a rrested in all cases. Hemorrhages reoccurred in 2 cases, and in 2 pati ents who had permanent balloon occlusion of the internal carotid arter y, transient ischemic attacks occurred, which appeared to be related t o temporary collateral reserve failure. No permanent neurologic compli cations ensued. CONCLUSION: Our recent experience with carotid blowout syndrome suggests that this clinical diagnosis represents a heterogen eous group of angiographic pathoetiologies that the physician should e valuate carefully before proceeding with endovascular therapy. Specifi c endovascular approaches depend on the pathoetiologic mechanism of ac tive or impending hemorrhage and the urgency with which intervention i s required.